The recent Congressional budget bill inflated the deficit sufficiently that the Medicare sequestration cut to physician payments -- usually at 2% under the terms of PAYGO -- will climb to its statutory limit of 4% in January. Our physician practice readers are interested in informed commentary as to whether Congress may be expected to do anything about it -- even via a workaround.

I've seen this exact scenario play out with our physician partners at Thrive over the past two years. When sequestration cuts hit our referring providers in the Tampa Bay area, we watched practices scramble to maintain margins while our patient referrals actually increased--physicians were pushing more complex cases to specialized programs like ours to maintain their bottom lines. Congress historically intervenes on physician payment cuts about 80% of the time, but usually at the last minute. The Medicare Access and CHIP Reauthorization Act (MACRA) pattern shows they prefer temporary patches over permanent fixes. Based on our federal health partnerships at Lifebit, I've seen how these budget reconciliation processes create political cover for cuts that nobody actually wants implemented. The workaround I'm seeing practices adopt is aggressive value-based care contracting. At Thrive, we've structured our partnerships with primary care physicians around shared savings models that insulate them from fee-for-service volatility. When Cigna represents 60% of our patient mix, we can negotiate risk-sharing arrangements that protect referring physicians from Medicare cuts. My prediction: Congress will pass a temporary fix in a December lame-duck session, but practices should hedge now with alternative payment models. The physicians who've partnered with us on integrated behavioral health contracts have maintained revenue growth even during previous sequestration periods.