Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Compromise 'Doc Fix' Bill Scored by CBO

By Emily Ethridge

February 27, 2014 -- The bipartisan, bicameral compromise measure to replace how Medicare pays physicians would cost $138.4 billion for 2014 through 2024, according to the latest Congressional Budget Office (CBO) estimate, and lawmakers are struggling to find a way to pay for it.

The score is on the lower side of cost estimates for various measures that would repeal Medicare's sustainable growth rate and replace it with new payment systems. The bill (HR 4015, S 2000) represents a policy agreement among three committees—Senate Finance, House Energy and Commerce and House Ways and Means—and has the backing of several provider groups.

The CBO noted that this most recent estimate is an 11-year score and includes a cost for fiscal 2024, whereas all the previous scores included costs only through fiscal 2023. Through fiscal 2023, the compromise bill would cost $122.3 billion.

Previous versions of replacement legislation approved in committee had CBO cost estimates ranging from $121.1 billion over 10 years to $153.2 billion over 10 years.

But a more immediate problem looms—lawmakers have only one month before the current "doc fix" patch (PL 113-67) expires and physicians face a 24 percent cut in their Medicare payment rates beginning April 1.

Rep. Charles W. Boustany, R-La., has said that lawmakers are working on a "parallel track"—continuing to work on moving the replace bill forward while also coming up with another short-term patch that could perhaps last through the rest of 2014.

"What's complicating things right now is the discussion on payfors," said Boustany, noting that new Senate Finance Committee Chairman Ron Wyden, D-Ore., is still "staffing up." Wyden became chairman earlier this month when Max Baucus, D-Mont., left the Senate to become ambassador to China.

The CBO's score shows lawmakers the exact parameters of that discussion, and the major challenge of offsetting the bill's cost. The CBO estimate says that nearly all of the bill's estimated increase in spending would come from updates in rates paid for physician services.

The bill would maintain current rates for 2014 and give providers 0.5 percent annual payment updates for 2015 to 2018. After that, individual providers' payments would be adjusted based on whether they participate in an approved alternative payment model or a new Merit-Based Incentive Payment System.

Establishing those two programs would increase Medicare spending by $6 billion for fiscal 2014 through fiscal 2024, the CBO said, with the expectation that most providers will choose the program that is most financially rewarding for them.

Boustany said he is "still optimistic" about the replacement bill's chances, even with time running low and the offset challenge ahead.

"We have an opportune moment now to do this. We really should seize it and do everything we can to make it happen," said Boustany. "Cause if we don't, I'm afraid we'll be stuck with patches for a long time in the future and we'll have missed a historic opportunity."

Publication Details