Doc Fix anyone know what this actually does or how it affects primary care like family practice?
Doc fix
- Thread starter MrSunny1
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The "Doc Fix" was the (frankly offensive) name given to the repeal of the "Sustainable Growth Rate" medicare formula.
Basically, way back in 1997, congress passed a law that had a formula that limited the maximum medicare would pay all physicians based on GDP growth. Unfortunately, the volume of medical expenses grew faster than GDP, which meant that if the formula was enacted as written, reimbursement for any given procedure would have to fall. This happened once (2002 or 2003ish) where reimbursement was cut 5% across the board. Obviously, this drove people nuts, so when it came up again the next year (and the next year...), they convinced congress to delay any cut (or even give a slight increase that was usually less than inflation).
This situation continued year after year with the proposed cuts getting ever larger (up to almost 30%) as congress kicked the can down the road without enacting a permanent fix. Every single person in DC knew there was no !@#$ing way that they could ever cut reimbursement by 30% across the board without every physician in the country either going bankrupt or refusing to see medicare ever again, but they didn't want to change the formula permanently because of shenanigans related to how budgeting works in Congress. A temporary fix "cost less" than a permanent one. Sometimes the legislation for the temporary fix came so close to the wire that they had to retroactively give money back, and it was an absurd situation.
Finally, in 2015, as part of the legislation that enacted MACRA (one of the new rolled-together quality reporting initiatives) and renewed CHIP (the childrens health insurance plans), the physician lobbying groups (AMA and whatnot) managed to get a permanent doc fix in there and passed. MACRA has plenty of downsides on its own, but it at least got that guillotine out of the way.
What does this mean for primary care or any other field? Absolutely ----ing nothing. It got rid of a phantom cut that never would realistically happen, and has no effect on how the money is split up (which is determined by CMS via medpac, the AMA-run RUC, and other stakeholders). MACRA implementation may decrease reimbursement for some people as "pay for performance" is implemented, but that's a separate, super complicated topic.
D
deleted480308
It was a trick to slide in the end of pay for service. It was not a win for doctors
Wow thank you. That's very helpful and nice to get some history. I guess I'm wondering how this new policy will address the issue of ballooning healthcare costs? Does it intend to decrease government spending on healthcare at all? The budget needs massive cuts to healthcare in order to stabilize the deficit and massive debt we are currently piling on. I guess I'm wondering how this "docfix" is even addressing the ballooning deficit.
I have not read any of the bill nor do I know how it will effect physician salaries but I'm just guessing there are many many measures in there that will decrease healthcare spending. Probably such as stricter monitoring of physicians, more stringent coding requirements/denials, penalties for many different things, .....
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Short answer:
It's complicated.
Long answer: There's a lot of different pay-for-performance schemes that purport to limit the rate of growth of healthcare spending, many of which were rolled into MACRA, with there also being some "alternative payment models" in there as well. No one really knows how those are going to be implemented. Read up on MACRA and it's components (MIPS/APM) with the understanding that in the first few years it will really only affect <5% of payments. Time will tell how much of a real change is going to happen.
