Why Congress can't avoid Medicare cuts to docs

• That would be a departure from Congress' perennial practice of passing short-term funding patches, or doc fixes, to offset scheduled cuts.

Driving the news: Medicare administrators have proposed a physician rate cut of as much as 1.68% for 2027 — along with reduced payments for office visits that occur on the same day as a surgical procedure, to address possible overlap.

• Those and other changes would strengthen primary care, improve patient outcomes and support Medicare's long-term sustainability, according to the Trump administration.
• But the proposals are prompting an outcry from medical providers — particularly specialties like otolaryngology, ophthalmology, dermatology and other disciplines that tend to pair office visits with same-day procedures.

• Reduced payment for a procedure like removing a skin lesion would fall below some independent practices' cost of providing the service, the American Medical Association and state and national medical specialty societies wrote to Centers for Medicare and Medicaid Services, urging officials to drop the idea.
• Groups like the California Medical Association say the economics of the proposal could discourage physician practices from treating patients who need a medically necessary procedure after a doctor's visit, adding costs, travel and inconvenience.

Zoom out: The prospect of more health system complications isn't welcome on Capitol Hill, where both Republicans and Democrats already are worried about undercutting patient care during a broader affordability crisis.

• Members at a House Energy and Commerce Committee hearing last week expressed frustration with the current physician reimbursement system and the annual cycle of short-term patches.
• Some are coalescing around a bipartisan overhaul plan that would establish automatic annual payment updates tied to inflation. It also would launch a pilot program that gives primary care practices a monthly payment, on top of payment for regular services.
• "The bipartisan enthusiasm [at the hearing] showed how support in Congress for a permanent Medicare payment redesign is growing," Capstone analyst Will Humphrey wrote in a note.

Congress went down this road before, with a 2015 remedy that tried to solve the physician payment problem once and for all but ultimately couldn't keep up with rising practice costs.

• Some of the sentiment for change this time is driven by broad shifts underway in the health system.
• With nearly 7 in 10 U.S. medical practices now owned by hospitals or other corporations, backers of the overhaul say it's time for a payment system that keeps independent practices sustainable so doctors won't sell their businesses.
• That could slow the pace of the health system consolidation that's been blamed for driving up the cost of care.

Reality check: Congress doesn't have the bandwidth to tackle legislation of this magnitude before the elections, or even in a lame-duck session at the end of the year. The House is out of session until after the elections.

• A permanent payment fix could drive up Medicare spending by billions through its inflation-indexing. That added cost would require lawmakers to find offsets — which is no easy task regardless of which party controls Congress.
• That all means lawmakers will probably pass another short-term doc fix at the end of the year to offset the proposed 1.68% rate cut due to take effect Jan. 1.
• "The approaching midterms, thin margins in both chambers, and partisan and intra-party disputes over payfors and unrelated health care reforms all limit the likelihood of Congress passing meaningful health care legislation beyond typical year-end health extenders," Capstone's Humphrey wrote.

What we're watching: It's still possible that the administration drops some of the proposed payment changes before the rule is finalized.

• The first Trump administration made a similar proposal on same-day services in 2019 only to withdraw it later.