Year after year, because of Medicare’s flawed sustainable growth rate (SGR) formula, physicians face significant cuts in Medicare reimbursement. And time and time again, Congress intervenes with a short-term “fix” to prevent these steep cuts. In fact, Congress has employed 17 temporary fixes to override SGR pay cuts over the last 10 years. All these band-aid solutions for fixing the physician payment system only equate to an outcome of hurting patient access to care and adding uncertainty into our Medicare system.
But, maybe the time has finally come for Congress to do its job and fix the SGR problems once and for all. In recent weeks, the topic of the SGR has really begun to heat up and there have been lots of moving parts happening around Washington.
On Feb. 5, 2013, the Congressional Budget Office (CBO) released “The Budget and Economic Outlook: Fiscal Years 2013 to 2023,” which significantly lowered its estimate of the cost to permanently repeal the SGR formula. So what is the magic number? Well, the cost to repeal the SGR formula is now $138 billion over 10 years, down from $244 billion which is due to lower than expected growth in Medicare physician spending.
On Feb. 6, 2013, Reps. Allyson Schwartz (D-PA) and Joe Heck, DO, (R-NV) reintroduced the “Medicare Physician Payment Innovation Act of 2013,” (HR 574). This legislation seeks to end the SGR formula, reward high-quality care and lower health care costs.
On Feb. 7, 2013, the U.S. House Ways and Means and Energy and Commerce Committees released a promising framework for SGR reform entitled, “Overview of SGR Repeal and Reform Proposal.” In a nut shell, the proposal would repeal the SGR and replace it with a new fee-for-service program that would be based on the quality and efficiency of care (of course it’s a bit more complex than that, but given all the details haven’t been fleshed out let’s stick to that description).
Today, the House Energy and Commerce Health Subcommittee will hold a hearing titled, “SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System.” The hearing begins at 10:15 AM EST and while it’s unknown what will occur, you can watch a live feed here.
So with all this action on the SGR, neurosurgeons can only hope that Congress and all its counterparts are gearing up to replace the Medicare physician payment formula with a stable mechanism for reimbursing physicians thereby creating a delivery system which will promote high-quality, high-value, better-coordinated care to our patients. And, honestly, we couldn’t think of anything better then to have SGR reform be our Valentine this year (well, maybe IPAB repeal, but that’s a whole other can of worms).