Originally Posted by piscivorous
Actually fro the CBO scoring the doc fix by law had to be considered in their guesstimates; even if reality and legislative history says that it will never be enacted. It is one of the primary reasons for the administration's claim that it this boondoggle piece of crap legislation, which went unread before passage
, will produce savings from thin air.
This is slightly confused. The "Doc Fix" is actually the annual legislation that is passed to maintain the physician reimbursement schedule; if Congress does not enact the annual "Doc fix," Medicare reimbursement will drop.
The sustainable growth rate (SGR) was set by Congress in 1997 to control the growth of Medicare expenditures. The law mandates that fees be reduced if aggregate payments for services increase beyond the sustainable rate of growth. Congress has passed so called "Doc Fix" legislation every year since 2003 to put off the scheduled decreases in fees, and the cumulative impact of the doc fixes in the past 8 years has been to increase the size of the proposed fee reductions every year, in order to return to the sustainable growth rate. The Doc Fix passed this year will expire on 31 December 2011, and, if no further action (i.e., the next doc fix) is enacted, Medicare reimbursements will be cut across the board by 29.5% on January 1, 2012. The Obama administration proposed legislation to fix the problem but the proposals did not go through Congress.
The CBO can only base their estimates on what the current law says, and The scheduled 29.5% reduction in fees would create a situation for many providers (myself included), where the cost of providing care would actually exceed reimbursement, i.e., you lose money on every patient you treat. If Congress does not enact a Doc Fix by 2012 many providers will have to withdraw from participating in Medicare.
The current problem requiring the Doc fix legislation is the result of the legislation enacted in 1997, and both Republican-controlled and Democratic-controlled legislatures have collaborated in this unsustainable situation since that time.
Neither party has proposed legislation that will propose the increase in healthcare costs. The Ryan plan, which exempts people 55 or older from facing any changes, is like saying you are going to lose weight by continuing your current lifestyle and then telling younger people to go on an 800 calorie a day diet in 10 years.
Health care costs will continue to grow, as will expenditures, until we change the system to one in which providers are paid to achieve outcomes, rather than do procedures.