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For more than a decade, doctors who treat Medicare patients have been threatened with pay cuts due to a faulty formula of how doctors are reimbursed. But in a rare bipartisan agreement, the House of Representatives overwhelmingly passed a deal to permanently end the problem and reward quality of care, not quantity. Gwen Ifill learns more from Mary Agnes Carey of Kaiser Health News.
In Congress today, a rare and significant bipartisan agreement. The House of Representatives overwhelmingly agreed to repair Medicare. For over a decade, doctors have faced repeated threats of pay cuts. But this new deal would permanently end the uncertainty.
Plus, it put House Speaker John Boehner and Democratic Leader Nancy Pelosi in the rare position of being on the same side.
REP. JOHN BOEHNER, Speaker of the House: This will be the first real entitlement reform that we have seen in nearly two decades. And that's a big win for the American people.
REP. NANCY PELOSI, House Minority Leader:
I just have confidence that the quality of what we have done, what has been crafted in the House is really a good bipartisan initiative.
Here to explain the deal and how it would work is Mary Agnes Carey of Kaiser Health News.
Mary Agnes, there have been 17 patches, fixes, temporary fixes for this over the years. It's not a new problem. What changed this time?
MARY AGNES CAREY, Kaiser Health News:
A couple years ago, members of the House and the Senate, bipartisan member of the relevant committees, came together and decided a policy on how to move forward to pay Medicare physicians.
But they could never find the money to fix it. So, now what's happened is, there has been bipartisan agreement, as you say, in the House to simply say we're not going to finance some of this repeal of the Medicare payment formula — that's about $141 billion — to the deficit.
There are some things they are financing, but they have simply decided this is a hole that's never created, it's not one we have to fill, and we agree to just not finance it.
And is part of what the fix is that they're paying doctors for quality of care, rather than the quantity they provide?
MARY AGNES CAREY:
The current payment formula had incentivized providers, physicians to simply do more services. And so what the repeal does is takes a five-year path to doing exactly what you say, paying physicians on the quality of the care they provide, rather than the quality — the quantity, rather.
Well, not only that, but there is a financial piece. The temporary fixes they kept passing, that was actually more expensive than a permanent fix.
Right. Those came in at $170 billion, for example, the fixes that you talk about that have happened for the last 12 years. The actual repeal this time is $141 billion.
So, that's how they ended up on the same side?
That's part of the way they ended up on the same side.
And, also, there are also other provisions that attracted votes in that bill, for example, two years of additional funding for the Children's Health Insurance Program, more money for community health centers that enjoy bipartisan appeal, and also an extension of some Medicare policies, including one that permanently extends a program to help low-income beneficiaries pay for their Part B premiums.
Were doctors a powerful force in finally getting this done? I mean, they must not have liked the uncertainty from year to year to year.
No, they didn't.
Think about, if you're a physician and you take a lot of Medicare patients — and most doctors do take Medicare patients — every year, you're sitting down trying to figure out how Congress was going to pay you. Were they going to cut you? Were you going to get a three-month patch, or a three-month fix?
And so this created kind of a full-court press from the physician community and other patient communities and providers as well to say to Congress, fix this once and for all.
Does this fix have any effect on the Affordable Care Act? Is there a connection?
In the sense of moving Medicare to being a provider of more quality care, it certainly does.
There's programs in the Affordable Care Act that look at things called accountable care organizations, where providers work together to improve care or bundle payment or trying to reduce preventable hospital re-admissions, to make Medicare a more efficient provider of medical care.
Now, of course, what we had today was passage in the House. The president has signaled that he will sign it. Today, he actually praised John Boehner and Nancy Pelosi, which also never happens.
But the Senate still looms. Some Senate Democrats have been unhappy with just the compromise you were talking about, which is for the children's health program, saying they want it to be extended longer.
Right. They would like four years of additional funding.
And there is also some concern about other ways they're financing the package, including asking wealthier Medicare beneficiaries to pay more for than coverage, and starting in 2020 putting some limits on these very — they call them the first dollar supplemental Medigap policies. They're questioning, why should seniors pay so much for a Medicare physician payment fix?
So you might hear some of those concerns on the Senate floor.
What is the timing? This thing is do April 5? It's supposed to expire April 1?
April 1, that's right.
So, in theory, if a final fix isn't passed, a replacement formula isn't passed by April 1, doctors would see a 21 percent payment cut. But here's something that the Centers for Medicare and Medicaid Services, which oversees Medicare services, could do. They could hold those claims for about two weeks.
And, as we know, the House has already left on a two-week break. The Senate is in the middle of fighting over their budget resolution for the next fiscal year. They're expected to go tomorrow. So, while they may not take action on it now, they could take action on it when they return.
But it sounds like they're really closer to a deal now than they have ever, ever been.
Closer than ever before.
Mary Agnes Carey from Kaiser Health News, thank you, as always.
Sure. Thank you.
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