October 21, 2009: SB 1776 (“the Doc Fix”) is introduced in the Senate [but fails to pass]

November 19, 2009: House of Representatives passes HR 3961 (the Medicare Physician Payment Reform Act) [but Senate fails to pass]

December 19, 2009: Congress passes Department of Defense appropriations bill (HR 3326), providing 2-month reprieve from cuts to the Medicare physician fee schedule that was due to become effective January 1, 2010

December 24, 2009: Senate passes the Patient Protection and Affordable Care Act

March 1, 2010: CMS notifies contractors to hold Medicare physician claims for 10 business days

March 2, 2010: House and Senate pass HR 4691 (Temporary Extension Act), extending a wide range of expiring programs and postponing the sustainable growth rate cuts until April 1, 2010

March 10, 2010: Senate passes HR 4213 (American Workers, State, and Business Relief Act), which includes a provision delaying physician reimbursement cuts until October 1; because the House passed a similar version of this bill on December 9, 2009 (without any health-related provisions), the House and Senate need to reconcile the language before it can be signed into law, but fail to do so before spring recess

March 25, 2010: President Obama signs the Patient Protection and Affordable Care Act into law

April 1, 2010: CMS notifies contractors to delay physician pay cuts by 10 business days

April 15, 2010: Senate passes HR 4851 (Continuing Extension Act), retroactively reinstating physician payments for Medicare patients in April, and postponing the 21.3% cut until June 1, 2010

June 18, 2010: Senate passes an amended version of HR 3962 (Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act), providing a 2.2% Medicare physician payment update from June 1 until November 30, 2010

December 15, 2010: HR 4994 is passed and signed into law, providing a 1-year delay for the sustainable growth rate cuts in physician reimbursement by Medicare

April 15, 2011: Rep. Paul Ryan introduces House Congressional Resolution 34, which would reserve funds for Medicare reimbursement of physicians over the next 10 years

May 25, 2011: Senate votes down the Ryan proposal on a straight party-line vote

September 15, 2011: Medicare Payment Advisory Committee presents a proposal to repeal the sustainable growth rate using budgetary offsets, including a freeze on primary care reimbursement and a 5.9% cut for all other specialties for each of the next 3 years, followed by a 7-year freeze [but the AMA opposes the proposal, citing an existing 20% gap between reimbursement rates and practice expenses]