The ICD-10 Chronicles: How Congress solved one problem (for now) and created a whole new one | Behavioral Healthcare Executive Skip to content Skip to navigation

The ICD-10 Chronicles: How Congress solved one problem (for now) and created a whole new one

April 1, 2014
by Mark Hagland
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For those of us who have been wondering when the U.S. Congress would take action on the so-called “doc fix” issue—the need to do something to forestall massive Medicare physician payment cuts, based on a 1997 law known as the SGR (sustainable growth rate for Medicare physician payment), one that has never been fully implemented because of its impossibility to fully implement—Monday evening’s action was not the way to do it.

First of all, we once again got only a temporary “doc fix,” not the long-term solution to a problem that is now calculated in the hundreds of billions of dollars (yes, that’s right, by some estimates, as much as a couple of hundreds of billions that the federal government owes itself, depending on who’s counting, and how; indeed, the Congressional Budget Office had estimated the cost of a permanent "doc fix" at $316 billion in January 2012, then lowered it to $245 billion in August 2012, and then to $138 billion in February 2013--but the numbers are constantly shifting, because of changing forecasts for future Medicare spending). What’s needed, when it comes to the “doc fix,” is a complete reworking of the SGR, something that will be difficult for a politically polarized Congress to do—though my policy sources tell me that, behind the scenes, staffers from both major parties and from the two lead committees in Congress—the Senate Finance Committee and the House Ways and Means Committee—are preparing a long-term solution to be revealed most likely in mid-November, after the 2014 elections.

But even if we get a longer-term solution to the SGR problem, the fact that Monday’s temporary “fix” came with a huge asterisk is troubling. 


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Charlene Marietti

Executive Director, Editorial Initiatives

Charlene Marietti


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