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Toy tariff story

Nov 20, 2019

Challenges remain, even after the ‘Doc Fix’ gets fixed

Dan Gorenstein Mar 26, 2015
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Kicking the can down the road is old hat in Washington. But one of the cans that’s been kicked for nearly 20 years now has been, well, not kicked.

The House of Representatives, by a wide and bipartisan margin, voted for a more permanent solution to the perennial threats to how much Medicare reimburses doctors, the so-called “Doc Fix” legislation. And while the deal still needs to win Senate approval, to some, like American Medical Association President-elect Dr. Steven Stack, it’s a historic moment.

“I don’t want to pass the opportunity to thank Speaker Boehner and Leader Pelosi,” Stack says.

Now, Stack knows there’s almost no chance that kind of quote is ever published, but he wanted to say it anyway. Take it as a sign of the relief he’s cautiously feeling on behalf of the 94 percent of doctors who have worried about Congress cutting their pay.

“Having stability and predictability in physician payment is essential for quality of care and patient safety,” he says.

Under the bill, doctors would see a half percent bump in each of the next four years, well below the rate of inflation  the price they pay for predictability. There’s another price doctors may pay though, warns the Urban Institute’s Bob Berenson, namely more reporting requirements. Berenson says some lack the technology infrastructure to pull it off.

“Small practices will find this too much of a reporting burden and may just throw in the towel,” he says.

Another key provision would pay doctors more for high-quality care rather than the volume of care. Everybody loves that, says Harvard’s Dr. Ashish JhaThe trouble is it’s very hard to measure “quality.”

“We are going to focus on paying doctors for a lot of things. Some of which probably represent real quality and some of which clearly represent checking the box,” he says.

Jha says if Washington is serious about paying based on quality, the government must invest several billion dollars. Absent that, doctors may have more financial stability thanks to this deal, but less certainty about how to best serve their patients.

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