We all know that the federal government is back in business, but what is less clear is the long-term impact the shutdown may yet have on the oncology community. The House and Senate recently passed a continuing resolution to fund the government through January 15, and raise the debt ceiling until February 7.
It is good news that funding for new clinical trials is restored and the Centers for Medicare & Medicaid Services (CMS) will get back to writing the final rules for the 2014 Physician Fee Schedule and Hospital Outpatient Prospective Payment System. However, Congress passed a continuing resolution, which is legislation to continue funding discretionary spending at the same rate it had been funded, with the only update being for inflation. This means that funding has been restored at postsequestration levels, and the conversation continues about that impact on community cancer care. Also, CMS will delay release of the final rules until the final week of November, leaving only about a month for implementation of the new policies before January 1. What’s more, because of the timing, CMS may be forced to hold reimbursement payments for the first 2 weeks of January because Congress will probably address the Medicare cuts resulting from the sustainable growth rate (SGR) formula in combination with the budget.
What does this mean for SGR reform? With 2013 winding down and Congress focused on very little besides the budget and debt ceiling, hopes of passing reform this year are slipping away. This means we are looking at the probability of another “doc fix” to stave off the anticipated 24.4% cut to Medicare reimbursement. Congress has a long history of stepping in at the last minute to avert cuts created by this flawed formula. However, many in the advocacy community believed that this was the year to do away with the SGR, considering the low Congressional Budget Office score and with the House Energy & Commerce, Ways and Means, and Senate Finance committees all drafting legislation. There is still an outside chance that SGR repeal could get looped into a larger budget deal but, considering that the Senate Finance and House Ways and Means committees’ SGR repeal legislation is still expected to cost about $140 billion over 10 years and no offsets have yet been identified, Congress may wait until another day to take on that fight.
Come January, we may see ourselves in the same situation from which we just emerged—partisanship and political gridlock threatening another shutdown. While the conversation continues to be budget-driven, the Association of Community Cancer Centers (ACCC) will continue to work with members of Congress to preserve provider reimbursement and access to care for patients with cancer. ACCC continues to advocate for SGR reform among other topics of interest to community oncology. Please stay tuned for updates.