WASHINGTON — Physicians got closer to a so-called "doc fix" Nov. 19 when the House passed H.R. 3961, a measure that would spare them from a planned 21 percent Medicare pay cut in 2010 and "fix" the program's current physician payment formula.

Vigorous lobbying on the part of the American Medical Association largely focused on questions of patient access, an argument also used by advocates in the home care industry when describing the likely effects of competitive bidding. Last month, the AMA issued a list of "patient access hot spots" including 21 states and the District of Columbia where they said access to care and choice of physician is already threatened for Medicare patients.

Without the fix, according to AMA President-elect Cecil Wilson, MD, physicians face Medicare cuts of about 40 percent over the next five years. "In two years, the baby boomers will begin to reach Medicare age, and they will expect access to high-quality medical care to stay healthy and active as they age," Wilson said in a release. "Physicians want to provide this care, but they need to know that Medicare will cover the cost of providing 21st century medical care."

The $210-billion Medicare Physician Payment Reform Act of 2009 would cancel the scheduled pay cut set for January, boost physicians' pay by 1.2 percent in 2010 and permanently reform the sustainable-growth formula used to calculate reimbursement rates. The bill's cost, however, is not offset by cuts elsewhere. The good news for home care providers is that the bill includes no cuts to HME to make up for the revenue shortfall.

When the bill goes to the Senate for consideration, advocates warn that things could change. That chamber rejected a similar bill on a procedural vote in October.

The Senate health reform bill includes a short-term fix that would provide doctors with a 0.5 percent payment update in 2010, but Majority Leader Harry Reid, D-Nev., has indicated he hopes to take up a permanent fix after health reform legislation is wrapped up. Meanwhile, press reports confirmed Minority Leader Mitch McConnell, R-Ky., believed the Senate would ultimately reject the House bill.

"Fixing the Medicare physician payment formula once and for all is an essential element of comprehensive health reform," AMA President J. James Rohack, MD, said in a statement. "Congress needs to fulfill its current commitments as it considers expanding its obligations. Physicians must be assured of stable payments so they can continue to care for seniors, baby boomers and military families."