Like a broken record, physicians again are facing a Medicare reimbursement cut unless Congress intervenes. The Congressional Budget Office said Feb. 5 that physicians' reimbursement will be reduced about 25 percent in January 2014 as a result of legislation passed by Congress earlier this year cancelling a 27 percent pay cut that was to be implemented Jan. 1.

Congress for the past decade has passed a series of short-term payment fixes in large part because permanently fixing Medicare's physician payment system came with a huge price tag. CBO in its report on the federal budget and the economy gave physicians a glimmer of hope however that Congress could finally act to fix the system. CBO lowered the cost of freezing physicians' Medicare reimbursement over 10 years from $245 billion to $138 billion.

That likely will make it easier for Congress to develop legislatiion to fix the system, but finding a way to pay for it will remain the sticking point, since reimbursement to Medicare providers already has been reduced in the health care reform law and to pay for past physician pay fixes. So, the low-hanging fruit is gone.

The House Energy and Commerce and Ways and Means Committees are working on legislation to permanently fix the system, and the Energy and Commerce health subcommittee will hold a hearing on the issue Feb. 14.