Ef­fort looks to war sav­ings for SGR re­place­ment

Modern Healthcare - - FRONT PAGE - Rich Daly

Law­mak­ers urged to use war sav­ings to scrap SGR and find re­place­ment READ The “Win­dow on Washington” blog at mod­ern­health­care.com/washington

Law­mak­ers hash­ing out yet an­other tem­po­rary patch to pre­vent big cuts in Medi­care’s pay for physi­cians may have a nar­row win­dow to scrap the en­tire con­tro­ver­sial for­mula. Many provider groups are push­ing fed­eral leg­is­la­tors to seize the op­por­tu­nity.

A sce­nario for jet­ti­son­ing Medi­care’s sus­tain­able growth-rate for­mula emerged amid re­cently launched talks over House-passed leg­is­la­tion that would de­lay a sched­uled 27.4% cut for two years. In­stead of an­other pay patch, Democrats have urged the use of one-time sav­ings from the end of the Iraq War to cover the cost of re­plac­ing the for­mula.

Some lead­ing provider groups have joined that ef­fort as a way to avoid the cuts to non­physi­cian providers—whose re­im­burse­ment was re­duced to pay for the patch—and as a fleet­ing chance to end the years­long drama of Congress scram­bling to avert a cy­cle of loom­ing cuts.

“We’ve talked to a num­ber of Re­pub­li­can of­fices” about the pro­posal to scrap the SGR, said An­ders Gil­berg, se­nior vice pres­i­dent of gov­ern­ment af­fairs for the MGMA. “They’re not com­pletely op­posed to the idea of it, so that’s what we’re pur­su­ing.”

Repub­li­cans, es­pe­cially the mem­bers of the GOP Doc­tors Cau­cus, said they strongly sup­port re­plac­ing the SGR but do­ing so in a fis­cally re­spon­si­ble way.

Crit­ics of the claimed sav­ings from war spend­ing, known as Over­seas Con­tin­gency Op­er­a­tions fund­ing, de­scribe it as an ac­count­ing gim­mick that ex­ists only on con­gres­sional bud­get doc­u­ments that au­to­mat­i­cally project for­ward all cur­rent spend­ing as on­go­ing. Those pro­jec­tions will dis­ap­pear when Congress passes a new de­fense spend­ing bill.

But pro­po­nents of us­ing that sav­ings—suf­fi­cient to cover the nearly $300 bil­lion 10-year cost of re­plac­ing the Sgr—view it as ap­pro­pri­ate be­cause they say the Medi­care physi­cian for­mula also amounts to an ac­count­ing gim­mick. That is, Congress cre­ated the SGR for­mula as a way to con­strain the growth of the pro­gram, but Congress has re­peat­edly waived it over the last decade and its mem­bers widely view im­ple­ment­ing such cuts as un­re­al­is­tic.

The use of the war off­sets is ap­par­ently gain­ing ground among con­gres­sional Repub­li­cans, with sev­eral re­port­ing that they sup­port us­ing some ver­sion of the fund­ing for a per­ma­nent repeal.

“Mo­men­tum is build­ing to use the war sav-

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