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Doctors to face Medicare cuts unless Congress acts by April 15

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Andriy Solovyov

Doctors across the country will face a 21 percent cut in government payments for treating Medicare patients if Congress does not act to prevent it before April 15, an official with the Centers for Medicare and Medicaid Services warned Wednesday.

The cuts to Medicare provider payments technically went into effect on April 1, but the agency said it was permitted to withhold those payments for two weeks to allow Congress time to pass the so-called "doc fix."

"Because we have an obligation to make sure that physicians are paid for services furnished, starting on April 15, we will begin to process claims at the 21 percent lower payment rate if the law is not changed," a CMS official said in a statement.

The cuts are the result of Medicare's "sustainable growth rate" (SGR) -- a payment formula implemented in 1997 that cuts provider reimbursement rates if health care costs grow faster than the overall economy. Because that's frequently the case, since 2003, the cuts have been scheduled 17 times. And because the cuts are politically radioactive, Congress has averted them all 17 times.

This year it seemed like lawmakers would put the issue to rest for good. On a wide bipartisan vote, the House of Representatives passed a $200 billion bill last Thursday that would have rescinded the SGR for good. The cost of the compromise, brokered by House Speaker John Boehner, R-Ohio, and House Minority Leader Nancy Pelosi, D-California, would have been partially offset by modestly trimming provider payments and increasing premiums on wealthy Medicare beneficiaries.

It was a fairly stunning bit of bipartisan dealmaking from a House that often seems to exist in a state of perpetual warfare, and it looked like the Senate would quickly follow suit. Senate Minority Leader Mitch McConnell, R-Kentucky, predicted the bill would clear the chamber by a wide margin.

But on Friday morning, the Senate punted the issue after a small contingent objected to its swift passage. "There wasn't unanimous consent," McConnell spokesman Don Stewart told The Hill newspaper.

Congress is currently out of session, but senators will take up the issue when they reconvene on April 13. They'll have only two days to fix the SGR, either temporarily or permanently, before it hits providers.

CMS has emphasized that providers will be reimbursed for any payment cuts they absorb if lawmakers eventually reach an agreement.

"Should Congress act subsequently, CMS will reprocess those claims paid at the lower payment rate to reflect the new payment rates," an agency official said.