SGR fix is back on for a bit, but doc­tors re­main frus­trated by process PHYSI­CIANS:

... but jury-rigged SGR so­lu­tion still frus­trates docs

Modern Healthcare - - News - Jen­nifer Lubell

Abold pledge from the gov­ern­ment’s top health­care ad­min­is­tra­tor to re­solve Medi­care’s physi­cian pay­ment prob­lem has yet to con­vince all doc­tors that a per­ma­nent fix will ever be re­al­ized.

The Amer­i­can Med­i­cal As­so­ci­a­tion’s Na­tional Ad­vo­cacy Con­fer­ence in Wash­ing­ton be­gan on a sour note last week when a 21.2% cut trig­gered by Medi­care’s sus­tain­able growthrate for­mula kicked in on March 1.

Al­though it was lifted by an emer­gency mea­sure signed by Pres­i­dent Barack Obama the fol­low­ing day, physi­cians were nev­er­the­less an­gered by the fact that the mea­sure—which pro­vided a se­ries of short-term ex­ten­sions to var­i­ous Medi­care pro­grams, in­clud­ing a 30-day stop­gap on the SGR cut— fell woe­fully short of pro­vid­ing a long-term so­lu­tion to this is­sue. (The tem­po­rary ex­ten­sion in­cluded health­care sub­si­dies for the re­cently un­em­ployed un­der the Con­sol­i­dated Om­nibus Bud­get Rec­on­cil­i­a­tion Act, com­monly known as the CO­BRA health in­sur­ance law.)

Ad­dress­ing AMA con­fer­ees, HHS Sec­re­tary Kath­leen Se­be­lius agreed with doc­tors that the cur­rent for­mula was in­ad­e­quate and promised to work with physi­cians to re­peal the SGR. “We are com­mit­ted to work­ing with all of you on a per­ma­nent fix, so you don’t have to spend your pre­cious time com­ing to Wash­ing­ton” to lobby on be­half of this is­sue, she said.

Her pow­ers as an ad­min­is­tra­tor to help doc­tors are lim­ited, how­ever, and some in the med­i­cal com­mu­nity won­der how sub­stan­tial this pledge was. “I be­lieve her sup­port is gen­uine,” said Joseph Stubbs, pres­i­dent of the Amer­i­can Col­lege of Physi­cians. “How­ever, the pledge is some­what empty in that the so­lu­tion will have to come from Congress and specif­i­cally the Se­nate. While she may be sup­port­ive, un­til we hear voices from the Se­nate in­di­cat­ing move­ment for a so­lu­tion to the SGR fix, we do not have a lot of re­newed hope,” he said.

Medi­care’s SGR for­mula for pay­ing doc­tors is based on the econ­omy’s health and has threat­ened pay­ment cuts to physi­cians ev­ery year since 2003. Congress has stepped in each time to en­act a tem­po­rary fix so that doc­tors won’t ex­pe­ri­ence ad­di­tional re­duc­tions to their Medi­care pay­ments, a move that only post­pones the cuts and has re­sulted in SGR “debt” that has piled up into the bil­lions over the years. Fed­eral ac­tu­ar­ies and oth­ers have es­ti­mated it would cost $210 bil­lion to $230 bil­lion over 10 years to per­ma­nently re­peal the SGR.

It’s a for­mula that has to be done away with, said Thomas Eppes, a mem­ber of the AMA and a fam­ily physi­cian in For­est, Va. “It’s the only way to pay doc­tors fairly to take care of their pa­tients,” he said. The Se­nate has his­tor­i­cally been the place where SGR re­form has gone to die. While the House man­aged to ap­prove a bill last year that sets in place a per­ma­nent fix, sim­i­lar at­tempts have failed in the Se­nate, mainly over ar­gu­ments that the fix would not be paid for. The lat­est ex­ten­sions bill, which pro­vided that 30-day re­prieve for doc­tors, was also held up in the Se­nate be­cause of par­ti­san squab­bling and par­lia­men­tary ma­neu­vers.

Some physi­cian leaders say Se­be­lius could make a dent with Congress—the Se­nate in par­tic­u­lar. “Dur­ing this one-month de­lay of the 21% pay­ment cut we en­cour­age ad­min­is­tra­tion of­fi­cials to share with the U.S. Se­nate the ur­gent need for re­peal of the for­mula, which hurts se­niors, mil­i­tary fam­i­lies and the ded­i­cated physi­cians work­ing to pro­vide high-qual­ity care,” the AMA’s pres­i­dent, J. James Ro­hack, said in an e-mail.

Se­be­lius “cer­tainly has the au­thor­ity to point out the im­pact on physi­cians,” said Lori Heim, pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians, who met last week with Se­be­lius in a pri­vate meet­ing. Heim said she be­lieved Se­be­lius was com­mit­ted to fix­ing the SGR, and “she could ad­vo­cate for it to keep the pres­sure on Congress.”

The SGR prob­lem is an in­con­ve­nience for the Obama ad­min­is­tra­tion as well as doc-

Eppes: The SGR for­mula “has to be done away with.”

Migliori: Tem­po­rary fix just “kicks can far­ther down the road.”

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