Healthcare Business News

Failure to replace SGR vexes doc groups

By Andis Robeznieks
Posted: January 3, 2013 - 12:30 pm ET

After the passage of another legislative "patch" postponing another scheduled decrease in Medicare pay for doctors, physician associations breathed a short sigh of relief and then called on Congress to repeal and replace the sustainable growth-rate Medicare reimbursement formula.

The American Medical Association and other groups have been practicing this exercise now for 10 years. This time, the threatened pay cut was measured at 26.5% and the cost of the patch, or "doc fix," was estimated at $25.2 billion. The cost to fill the budget hole covered up with 10 years of patches is now estimated at $300 billion.

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As they have done before, physician organizations have called on Congress to replace the SGR to restore trust in and stability to the Medicare system.

"This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients," Dr. Jeremy Lazarus, AMA president, said in a news release. "This instability stalls progress in moving Medicare toward new healthcare delivery models that can improve value for patients through better care coordination."

The American Academy of Family Physicians, also seeking a permanent SGR replacement, noted that postponed "sequestration" cuts called for by the Budget Control Act of 2011 still need to be addressed, too.

"Only through payment and delivery-system reforms that re-establish primary care as the foundation of our health system will we improve patients' access to comprehensive, coordinated services that prevent illness, that manage chronic conditions and avoid complications and that end duplication and fragmentation of services," Dr. Glen Stream, AAFP board chairman, said in a news release. "The sequestration's 2% cut in Medicare physician payment undercuts the positive impact of the 12-month patch to the sustainable growth rate. Such a cut perpetuates the cycle of instability that elderly and disabled Americans have suffered for more than 10 years."

The American College of Physicians, an internal-medicine association, noted its relief that the measure, called the American Taxpayer Relief Act of 2012, kept alive the provision of the Patient Protection and Affordable Care Act that temporarily raises Medicaid pay for primary-care services. Still, the bill "falls well short of ACP's goals of enacting a permanent replacement to the Medicare SRG formula and enacting a fiscally and socially-responsible alternative to across-the-board cuts," Dr. David Bronson, ACP president, said. A "greater bipartisan effort" will be needed in 2013 to pass legislation that supports "transitions to payment models that provide predictable annual updates to physicians participating in Medicare, while being aligned with the provision of high-quality and efficient care."

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