Obviously, every medical professional, not just in community oncology, is concerned about the general Medicare payment cut of 21.2% that looms on March 1, 2010. However, congressional action at the end of last week may be the prelude to addressing the “doc fix,” as it is referred to on Capitol Hill.

At the end of last week, the Senate passed a variation of a House bill that would increase the national debt ceiling and institute a pay-as-you-go (paygo) rule. This would require any legislation that spends federal money to be offset with corresponding spending cuts and/or revenue raisers. In this way, at least on paper, new legislation would not increase the national debt. We say “on paper” because Congress always finds ways of skirting any fiscal discipline that it tries to enact.

The paygo legislation would actually exempt spending to a certain limit on the Medicare “doc fix.” Although the AMA is running commercials to fix the payment system by eliminating the flawed sustainable growth rate (SGR) formula, this effort will likely be futile. We say that because the paygo legislation passed by the Senate would not exempt the entire $200+ billion required to fix the SGR. Instead it would exempt enough funding to patch the SGR for about 5 years.

Why a 5-year patch of the SGR? First, it removes the controversial issue from both the upcoming 2010 and 2012 election years. The second reason is more troubling. The Senate health care reform bill would create an Independent Medicare Advisory Board, which would be empowered to cut Medicare spending when it is projected to be unsustainable. As a result, the Board could do what Congress has failed to do, which is to actually let Medicare payment cuts to be implemented without Congress facing the wrath of the medical community and seniors. The Board could do this when the 5-year patch expires.

The House will soon address the debt ceiling and paygo legislation. In the meantime, although health care reform has been taken out of the spotlight, behind the scenes the Democratic leadership is working very hard to keep comprehensive health care reform alive. They are working on procedural moves that would allow them to use the budget reconciliation process, which only requires a simple vote majority in the Senate.

We will provide updates as we learn more, based upon your requests for information on the status of the 21.2% payment cut. We underscore that nothing is definite until legislation averting the 21.2% Medicare payment cut is signed into law by the president. Until then, the crippling 21.2% cut looms.