Still looking for relief
While docs push for SGR fix, experts say it’s unlikely to be in reform package
With health reform legislation edging closer to final passage, some physician groups are banking on Congress to address the flawed Medicare payment system within the context of larger reform—rather than in its aftermath.
Their reasoning is that a physician payment fix will get lost in the shuffle once healthcare reform is approved, prompting lawmakers to once again slap a Band-Aid on the problem instead of fixing it for good.
Whether it’s addressed within the bill or concurrently as a companion bill, the doctor fix can’t wait, said Lori Heim, president of the American Academy of Family Physicians.
For that reason, the AAFP is recommending a permanent fix “sometime during the conference debate as part of healthcare reform.”
If inserted into the actual bill, this “fix” would add another $200 billion to the overall cost of the health reform package, putting pressure on lawmakers to find a way to pay for it.
Physicians want 2010 to be the year that Congress finally addresses Medicare’s troublesome sustainable growthrate, or SGR, formula, which is based on the economy’s health and by law is used to calculate the change to physicians’ Medicare reimbursement.
The SGR has produced results that would have cut payments to physicians every year since 2003. Congress has stepped in each time to enact a temporary fix so that doctors wouldn’t experience additional reductions to their Medicare payments.
A 21.2% cut scheduled to take effect this month was pushed back until March 1 under a provision in a spending bill signed into law last month, buying Congress some additional time to come up with a permanent fix. How they’ll attempt to fix the problem is anyone’s guess.
Whatever form it takes, groups such as the American Medical Association have made it clear they don’t want a short-term solution. “We had said from the start that we would not support another temporary fix,” said Cecil Wilson, president-elect of the AMA.
This pressure from the physician lobby encouraged the Senate to take a oneyear solution to the SGR problem out of its reform bill in late December. On the other side of Capitol Hill, House lawmakers approved a permanent fix, but it was done outside of the context of
Golden: Physicians see the SGR fix as fundamental to reform.