This year, the fix got hung up in larger budget politics. Although a reprieve is expected sooner or later, doctors don't like being told to sit in the congressional waiting room.
"It seems like there is a presumption that physicians and patients can basically tolerate this kind of uncertainty while the Congress goes through whatever political machinations they are going through," said Dr. Jeremy Lazarus, president of the American Medical Association. "Our concern is that physician uncertainty and anxiety about being able to pay the bills will have an impact on taking care of patients."
A recent government survey indicates that Medicare beneficiaries are having more problems when trying to find a new primary care doctor, and Lazarus said that will only get worse.
Adding to their unease, doctors also face an additional reduction if automatic spending cuts go through. Those would be triggered if Obama and congressional leaders are unable to bridge partisan differences and strike a deal. They are part of the combination of tax increases and spending cuts dubbed the "fiscal cliff."
Medicare service providers would get hit with a 2 percent across-the-board cut, but Medicaid and subsidies for the uninsured under Obama's health-care overhaul would be spared. The Medicare cut adds up to about $120 billion over ten years, with 40 percent falling on hospitals, according to Avalare's analysis. Nursing homes, Medicare Advantage plans and home health agencies also get hit.
The American Hospital Association says that would lead to the loss of hundreds of thousands of hospital jobs in a labor-intensive industry that also generates employment for other businesses in local communities.
"It's very difficult to believe hospitals can absorb the kinds of numbers they are talking about without reducing service or work force," said Kirby, the hospital association head. "You may decide that a service a hospital provides is not affordable -- for example, obstetrics in a rural community -- if you're making a little bit of money or losing a little bit of money by continuing to deliver babies in a rural community."
Independent analysts like Mendelson doubt that a 2 percent Medicare cut to hospitals would be catastrophic but say it will cost jobs somewhere.
Even if there is a budget deal, the squeeze will be on.
The administration has proposed $400 billion in health-care cuts so far in the budget talks, coming mainly from Medicare spending. That's only a starting point as far as Republicans are concerned. They also want to pare back Medicaid and Obama's health-care law, and they also have sought an increase in the eligibility age for Medicare.