If and Buts, Candy and Nuts…

Merry New Year, ProviderNation.

You’ve already heard about Sen. Max Baucus’ promotion. Whatever it means for the nation’s China policy, it raises some questions about what happens in the effort to correct the physicians’ formula under the sustainable growth rate (SGR), better known by its nom de guerre, the doc fix.

As you recall, Baucus, D-Mont., chairs the Senate Finance Committee and was expected to begin shepherding a 10-year reform plan through a conference committee—perhaps as early as January. But with Baucus now awaiting confirmation, some in Washington are wondering whether the deal will get done.

Next in line for chair of the committee is Sen. Jay Rockefeller , D-W.V., who is retiring after the next election and is unlikely to assume the chairmanship. Behind him is Sen. Ron Wyden, D-Ore. Rockefeller and Wyden have spoken warmly about the 10-year reform plan, but if Baucus is confirmed before the legislation is finished, it may delay a doc fix bill while staffers are shuffled about.

Under ordinary circumstances, this might be a mere pause. But you’ll recall that until recently, Congress had outlawed the use of the phrase “ordinary circumstances.”

The doc fix proposal, which has broad, in-principled support from both parties, only came about in the fall, when a sudden fragrance of bipartisanship could be sniffed in the halls of Congress. Most lobbying-American types I spoke to don’t expect that scent to linger for much longer because the elections of 2014 are coming up.

That means that time is of the essence.

Further complicating things is that, even should a doc fix bill get hustled through (and there is good momentum behind it: the Congressional Budget Office has given it the best score in years, at a paltry $116 billion), the nasty question—who pays?—will still be open. One lobbying-American type I spoke to said that Baucus was a bit more sortable on the question.

“The Baucus announcement is a hurdle (should he leave the Senate during final repeal negotiations),” the lobbying-American type told me, “but it is one hurdle of a few.”

But no one expects the pay-for fight to be sweet no matter who is in charge. Just this week, the Partnership for Quality Home Healthcare sent a whiff of grapeshot Washington’s way when it decried a CMS rule that cuts home health’s rate by 3.5 percent per year for the next four years. The cuts will put about 40 percent of the nation’s home health providers in the red for next year. Imagine how happy that outfit will be to shell out even more for the doc fix…

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