Still looking for re­lief

While docs push for SGR fix, ex­perts say it’s un­likely to be in re­form pack­age

Modern Healthcare - - The Week In Healthcare - Jen­nifer Lubell

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.

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