Here's another issue that may bubble up in controversy in years to come:
The law creates an independent payment advisory board (IPAB) to develop and submit to Congress a report on matters related to Medicare. In certain circumstances, the IPAB would have the authority, beginning in 2015, to make binding Medicare policy recommendations and non-binding private payer policy recommendations to Congress.
Jessee worries about the future IPAB and what it could portend for physician payments. He likens its potential clout to that of the Base Alignment and Closure Commission in the military, which has enormous power over military bases.
"Empowering an IPAB with authority to make binding Medicare policy recommendations based on expenditure inflicts physicians with additional expenditure constraints," he says. He describes it as "MedPac (Medicare Payment Advisory Commission) on steroids."
Whether Jessee is right on this remains to be scene. But it swirls around physician pay, and so I'll transition right now to the continual "doc fix" problems. This is No. 1 on Jessee's agenda, and a significant reason for his disappointment in the healthcare reform laws. For Jessee, it's the controversy that continues to exist although headlines have died for awhile, at least until the next time around Congress acts.
Here's the latest: a proposed 21 % pay cut was halted through May 31, 2010, and Congress is expected to take up legislation to extend the current payment rate until Oct. 1. The House and Senate have passed separate bills to achieve this extension, and negotiations are continuing about how it will be paid for.
"All the word on Capitol Hill is they intend to do something to repeal the SGR and fix the problem," Jessee says. "Quite frankly, we've heard that story before."
Just another day in the sausage factory.