Illustration: Rebecca Zisser / Axios
The House Ways and Means Committee is eyeing a markup this month of legislation that would overhaul Medicare's physician payment system, sources say, increasing the probability of a "doc fix" getting added to a lame duck package.
Why it matters: Doctors have long complained about the almost-annual rite in which they have to appeal to Congress to delay scheduled cuts to their Medicare pay, and lawmakers are looking at longer-term solutions.
What they're saying: "I've been intimately involved in that," Rep. Greg Murphy, a urologist and Ways and Means member, told Axios when asked about a physician payment markup, adding that the panel is "hoping" to have it this month.
- Although longer-term efforts to give doctors more stability and prevent cuts to their Medicare payments are likely to be taken up in committee, Murphy conceded that there may be time this year for only a temporary fix.
- "[We'll] probably end up doing a short-term patch, but we have to get our Senate colleagues to realize that physician pay should not be a partisan issue," he said.
- Lobbyists have said it's likely that the committee will also mark up unspecified rural health care legislation this month.
Ways and Means Ranking Member Richard Neal, though, told Axios that details of the markup are "elusive" to him, and that he doubts it will be a bipartisan effort.
- "I preferably would have a bipartisan bill [on doctor pay], but if we have to wait until the lame duck we have to wait until the lame duck," he said.
- A spokesperson for committee Republicans declined to comment when asked about the markup plans.
Physicians face a 2.8% cut in pay under the proposed 2025 Medicare physician payment schedule published in July, following a 1.69% reduction in 2024 and 2% drop in 2023, per the American Medical Association.
What's inside: It's possible that lawmakers on the committee could consider legislation that is similar to the discussion draft that the GOP Doctors Caucus released last year, per a House aide and a lobbyist.
- That bill would make certain changes to the Medicare Physician Fee Schedule, including raising the threshold for budget neutrality from $20 million to $53 million to help accommodate rising provider costs. That threshold hasn't been updated since the fee schedule was established.
- It would also require CMS to look at utilization of services and utilization estimates, and alter the payments to providers if there is a difference between the two.
- The legislation would also require CMS to have a timely update of the direct costs that are used to calculate practice expenses around clinical staff wage rates, medical supplies and equipment, and limit the year-to-year variation to no more than 2.5%.
The big picture: Several GOP physician-lawmakers are retiring and looking for progress on payment reform before they leave.
- "We're trying from the Doctors Caucus anywhere we can. We've got a lot of people retiring," said Rep. Brad Wenstrup, adding that he would "love to" get physician payment reform done before he leaves at the end of this session.
Flashback: On the Senate side, Finance Committee leaders released a bipartisan white paper on physician pay changes in May, but more time could be needed to get a final product into law.
