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Report: Permanent “Doc Fix” Bill in the Works

March 13, 2015
by Rajiv Leventhal
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Congressional members are negotiating a “doc fix” deal that will permanently abolish Medicare's Sustainable Growth Rate (SGR) formula, according to a report from Modern Healthcare.

The SGR is the formula for physician payment established under Medicare since 1997, and has been repeatedly "fixed" in order to avert physician payment cuts under Medicare. Without congressional action, the SGR formula calls for a 21 percent cut in physician reimbursement when the current short-term patch expires March 31.

Last year, Congress again only “patched” the issue temporarily, which provided a 12-month delay to the March 31, 2014 expiration date of the SGR "doc fix.” According to press reports, speaker of the House of Representatives John Boehner (R-OH) and House Minority Leader Nancy Pelosi (D-CA) are negotiating the “doc fix” deal in Congress this year. According to those reports, is important to note that the two sides are still in negotiations, which have been ongoing for the past few weeks.

Modern Healthcare has reported that the deal will include a two-year extension of the Children's Health Insurance Program with a total cost exceeding $200 billion. The report goes on to say that about $70 billion of that is expected to be offset by spending cuts, to be split roughly evenly between cuts to providers and changes to benefits.

Many are also wondering if the “doc fix” will include another delay to ICD-10, as it has in the past. Much of the health IT industry remains opposed to another ICD-10 delay, and are in favor of keeping Oct. 1, 2015 as the official deadline for ICD-10 implementation.

Healthcare Informatics will keep you updated on this story as it progresses. 



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