Things have gotten so pitiful in Washington that political reporters – being anxious to share any news their audiences might find not depressing – are apparently falling over one another buying into the idea that a divided city can suddenly  come together and address the $174 billion political juggernaut of Medicare reimbursement for physician services. Using words like momentum, enthusiasm and optimism they report that Congress is advancing on a permanent Doc Fix.

Oh, please.

The rightwing of the Republican Party has already made clear its intent to use intransigence as the primary tactic to implement a strategy of growth through attrition in this 114^th Congress.  And the only hope for securing Democratic support to bridge the voting gap left in their wake will be if those Democrats subscribe to Ms. Pelosi’s edict of not reading healthcare legislation before voting on it. Because if they actually read it, they will in all likelihood not be happy at the entitlement program cuts needed to fund the fix.

Alternatively, funding offsets could be achieved on the backs of other clinical providers and Medicare recipients. Those have always been pushover constituencies with poor lobbying representation, right? Or, to steer clear of that minefield legislators could assume funding offsets will come from expanding value-based payment models and continued implementation of other ACA reforms (e.g., lowering of hospital readmissions). That should be an even easier sell with Conservatives in Congress (yeah, more sarcasm).

And let’s not forget the public and private enterprise investments made into ICD-10 implementation, which Republican lawmakers would probably seek to delay as part of SGR repeal. That will be a contentious ideological battle separate from not having $174 billion at hand.

See what I’m getting at?

All this has to be worked through before physicians face an average reduction of 21.1% in Medicare payments in less than three weeks. Physicians who are already nearing their human capacity and ability to fight through the regulatory obstacles that impede helping their patients.

So don’t buy into the hype: 2015 looks a lot like 2002, 2003, etc. – time once again to kick the can down the road.

Cheers,
  ~ Sparky