Congress Reaches Short Term Deal on Fiscal Cliff — What is Next?
The 113th Congress has been sworn in, but literally hours before the official end of the lame duck 112th Congress, they were still working to complete some of their unfinished business and prevent the fiscal cliff from occurring. I think everyone predicted that the fiscal cliff negotiations would go down to the wire, but Congress waited until the last possible hour to push through a deal that prevented the 26.5 percent Medicare physician payment cut from being implemented, provided tax changes and kicked the can for two months on the automatic spending cuts.
The drama unfolded over the holidays when House Speaker John Boehner, R-OH, who failed to push through his own “plan B” that would have increased taxes on those making more than $1 million a year, told the Senate to come up with a plan. Senate Minority Leader Mitch McConnell, R-KY, and Vice President Joseph Biden worked on a compromise plan that included increasing taxes on individuals making more than $400,000 a year and couples earning $450,000 a year. The plan also permanently fixed the alternative minimum tax, made changes to the estate tax, and extended the research and development tax credit that was popular among businesses. The deal prevented the Medicare physician payment cut of 26.5 percent for a year and prevented to the automatic spending cuts to NIH and other government programs from being implemented for two months. The plan easily passed the Senate, with 89 senators voting in favor of it. However, up until the last hour on New Year’s Day, it was uncertain whether the House would take up the plan. The House Republicans were divided, and many in leadership opposed the plan since it did not address spending cuts. However, in the end, the speaker brought the bill up for a vote, which ended up passing the House with the majority of Democratic members supporting it.
The deal also was a small victory for registries — the new law recognizes clinical data registries, such as the AGA Digestive Health Outcomes Registry®, in improving patient care and health-care quality outcomes. Beginning in 2014, physicians can report via registries to adhere to the Physician Quality Reporting System and other federal quality programs.
The AGA, along with other medical specialty societies that also have registries, worked with the House Ways and Means Committee to draft this language to give physicians more options in reporting true quality outcomes data. The House Ways and Means Committee and the Senate Finance Committee have been supportive of registries; this language stemmed from AGA’s testimony to the House Ways and Means Health Subcommittee in July during which we shared many of our quality improvement program initiatives, such as the AGA Registry. Registries would not necessarily have to use National Quality Forum-endorsed measures, although the secretary would have to consider whether the registry adheres to minimum standards related to physician feedback and transparency of specifications and risk-adjustment methodologies. The secretary is also required to consider whether the registry requires the submission of data from participants covered under multiple payors. We will continue to monitor the regulatory process on this issue and remain engaged with CMS as they develop their minimum standards and recognition process.
The initial fight on the fiscal cliff may be temporarily over, but another major budget battle looms as the 113th Congress needs to address raising the debt limit, as well as the automatic spending cuts. Since Congress only focused on the tax portion of the fiscal cliff, spending and entitlement reform will be the focus of the next round of discussions. Medicare reform will undoubtedly be on the table as Congress will be looking for long term savings to the program for deficit reduction. AGA and the entire medical community will continue to advocate that meaningful Medicare reform cannot be achieved without addressing permanent physician payment reform. We will continue to work with our champions in Congress to ensure that the issue is addressed in a comprehensive manner that ensures the long term solvency and stability of the Medicare program.
AGA will also continue to push for adequate funding for NIH and other federal research programs that not only help improve our nation’s health-care delivery system, but also boost our country’s economic competitiveness. NIH continues to be a smart investment for our nation to ensure economic growth and we will continue to convey that message.
We thank all of you who took time out of your busy schedules to make your voices heard during the fiscal cliff debate — you made a difference. We will continue to call on you in the future to help advocate for the science and practice of gastroenterology. Continue to look for updates as this debate continues in the 113th Congress on the AGA Washington Insider and AGA eDigest.