By Kay Tillow Original article on DailyKos.com.

House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) have worked out a deal, a permanent "doc fix" that would repeal automatic cuts in Medicare payments to physicians.  Their bi-partisan solution, if enacted, will plunge a stake into the heart of traditional Medicare, according to health policy expert Don McCanne, MD, of Physicians for a National Health Program.

Social Security Act amendments passed more than a decade ago once again threaten to slash Medicare payments to physicians, this time by 21.2%, as of April 1, 2015.  These provisions require automatic cuts based on a formula called the "sustainable growth rate."  

Each time these cuts threaten to kick in, Democrats and Republicans alike look for a solution to stop the harmful cuts.  Now Boehner and Pelosi have agreed on a permanent solution, a plan that stops those cuts, but at the unacceptable price of inflicting devastating damage on Medicare.

The Boehner/Pelosi-backed bill, HR 1470 “SGR Repeal and Medicare Provider Payment Modernization Act of 2015” is cosponsored by progressive James McDermott (D-WA), anti-Medicare Republican Paul Ryan (R-WI), and seven others from both parties.  The bill would replace the current formula for physician reimbursements with a new Merit-based Incentive Payment System (MIPS).

MIPS is an administrative nightmare, says McCanne.  

Expensive consultants will game the system bringing in additional incentive payments while those who work with disadvantaged patient populations will find it difficult to score higher points, predicts McCanne.  Those who serve less wealthy populations will see negative payment adjustments by up to 9%.

MIPS robs from the professionals who are trying to make the system work for their patients and gives the spoils to those who likely have consultants to show them how to game the system, says McCanne.

MIPS will apply only to traditional Medicare, promoting an exodus of physicians from traditional Medicare into the private for-profit Medicare Advantage plans.

The deal would also reward remote patient-monitoring and telehealth as clinical practice improvement activities, reports Darius Tahir of Modern Healthcare.   That can create big bucks for health information technology but does not portend well for patients who need hands on caring professionals.

According to The Hill’s Scott Wong and Peter Sullivan, the deal will be paid for through a combination of means testing – that is, making wealthier seniors pay more for Medicare – and reforms to the supplemental health insurance plans known as Medigap.  

Medigap policies would have to make the patients pay the first $250, providing the “skin in the game,” that ugly, inhumane concept so popular with insurance companies. The further means testing of Medicare threatens its broad based popular support as a benefit for all.

“The increased beneficiary cost-sharing included in the SGR reform proposal could work hand-in-hand with the larger House GOP Medicare plan by prodding seniors to choose the lower-cost private Medicare plans envisioned under the budget blueprint. That would advance their long-held goal of turning Medicare into a privatized, means-tested welfare program and getting the government out of the health insurance business,” reports Harris Meyer in Modern Healthcare.

Grover Norquist, founder of Americans for Tax Reform and known for wanting to shrink government small enough to be drowned in a bathtub, likes the Boehner/Pelosi deal.  Norquist says the “doc fix” deal could be a “model of success” for a larger entitlement deal.

The bill, negotiated in secrecy, is being steamrolled and is predicted to come to a vote this week.  Those who cherish Medicare as our nation’s best yet health program should sound the alarm.  A stab in the heart of Medicare is not a compromise but a complete and disastrous sell-out.