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 ‘Doc Fix’ Left Out Of Debt Ceiling Deal; Furious Lobbying As March 31 Deadline Looms

Doctors and their allies could claim a victory Wednesday after Congress passed a debt ceiling deal
without attaching a short-term fix for the Medicare physician pay rate. 
 
The vote means that the next few weeks will see furious lobbying from long term and post-acute care advocates as they offer up alternatives to billions of dollars of across-the-board budget cuts to make up for doctors’ Medicare rates ahead of a March 31 deadline.
 
Hoping to avoid another government shutdown, Congress on Wednesday approved a package of bills just before the President’s Day recess that would increase the nation’s debt ceiling by $1.2 trillion, extend cuts of the so-called sequester for another year, and add a small boost to military pensions. 
 
What wasn’t in Wednesday’s legislation was a bill that would have extended the current law for physicians’ Medicare rates for another nine months. House Speaker John Boehner, R-Ohio, had attached the extension to his debt-ceiling bill last weekend, hoping that it and the military pensions would make raising the debt ceiling more palatable to ultra-conservatives in his own party.
 
But organized doctors groups from the American Medical Association to AMDA (formerly known as the American Medical Directors’ Association) and their allies in the Republican Doctors’ Caucus pushed back, warning Boehner that the extension might jeopardize recent efforts to come up with a permanent solution to the so-called “doc fix.”
 
The doc fix has bedeviled Washington for nearly two decades, but House Republican and Senate Democrats have offered up legislation that would repeal the current law and replace it with a five-year plan, giving doctors a modest, annual increase in rates. The legislation was announced in early February and must be enacted by March 31 because current law on the doc fix expires then.
 
There has been broad agreement that the doc fix has to be reworked, but the February legislation leaves out the all-important question of which other Medicare sector will make up the difference. Experts estimate that the five-year plan could cost around $128 billion.
 
That’s why Boehner’s provisional extension was so tantalizing to long term and post-acute care advocates. Though not exactly thrilled with the sequestration’s extension (and the 2 percent cuts that come with it), provider advocates saw the nine months as time enough to let the doc fix legislation breathe. Boehner’s patch would have postponed any decision beyond November’s elections, and advocates hoped that a lame-duck Congress would be much more approachable.
 
Long term and post-acute care advocates worked the phones and The Hill furiously to try to keep the doc fix extension in Wednesday’s debt ceiling legislation.
 
But the profession has been readying itself since late last year, when a permanent, congressional doc fix drew its first breaths. After Wednesday’s vote, providers and their advocates find themselves reopening the folder marked, “Plan A.”

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