In addition to preventing the 24 percent Medicare cut, the law contains a number of other significant provisions including another one-year delay in the implementation of ICD-10 coding, a six-month delay in the implementation of the “2-Midnight Rule” for Medicare patients, and 50 other changes to health care payment or regulations under the Medicare program.

So what does the bill do financially for physicians? Well, the cost of the law in delaying the permanent Sustainable Growth Rate-formula fix for yet another year is $20 billion. Where will that money come from? About half will actually come directly out of physicians pockets, as the law contains a provision that will allow the Secretary of Health and Human Services to modify Medicare payments to physicians for “over-valued” services and also extends sequester cuts for another year at the end of the current 10-year program. The law also contained some “sweeteners” for hospitals in delaying the implementation cuts to the Disproportionate Share Hospital Payments made by CMS to hospitals to partially offset the amount of free care provided, and it also delays the implementation of additional Medicare Recovery Audits, referred to as RAC audits.

The end result of the passage of HR 4302 is that another opportunity for Congress to “do the right thing” and permanently repeal the flawed SGR formula has been lost. Rather than take advantage of significant work done by a number of Congressional committees to come up with a replacement program, the leaders of the U.S. House and Senate chose to yet again “kick the can down the road” and avoid making the difficult decisions that must be made to fix this problem once and for all.

Dr. Cirillo is director of health policy and legislative advocacy for Emergency Medicine Physicians in Canton, Ohio.