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The big health wonk news in today's Medicare report

The headline coming out of today's Medicare Trustees' report is that, due to the health care spending slowdown, the insurance program's trust fund will now last until 2030, four years longer than last year's projection.

But there's a nugget buried in the report that will be especially interesting to the health wonk crowd: it seems that, for the first time ever, Medicare is assuming that Congress passes a doc-fix.

For 12 years now, the formula that Congress uses to pay Medicare doctors has fallen short of keeping doctor salaries steady. So every year (and sometimes multiple times per year) Congress passes a "doc-fix:" a funding patch to keep physician salaries even, or given them a slight boost.

In previous Medicare Trustees' reports, the authors would never assume that they would pass this fix — they would only operate on the baseline of what law is standing right now (that would be the law that funds doctors at a lower rate). After 12 years of watching doc-fixes pass and pass again, the group has changed its stance.

"Because the physician payment reduction required by current law has been overriden for 12 consecutive years, the Trustees decided for the 2014 report to emphasize that projections reflect the current practice of modest payment increases in the physician fee schedule," they write.

In other words: the Medicare Trustees' are acknowledging that our haphazard way of funding doctor salaries, with short-term payments, is likely here to stay.

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