Lawmakers are trying to free up more money to fix Medicare’s long-standing physician reimbursement problem, but don’t yet have a plan for how to do so.
No fix in sight
Senate tackles SGR; docs still seek lasting solution
The Senate last week in approving a bill to raise the national debt ceiling inserted language to provide a “rainy day” fund of sorts to help fund a revamp to Medicare’s sustainable-growth rate formula for paying doctors. The formula is based on the economy’s health, and has produced results that would have cut payments to physicians every year since 2003.
The move frees up $82 billion to partially cover the cost over five years and does so in such a way that it doesn’t require offsetting cuts in other areas—as is often necessary—but doesn’t tackle the thorny issue of how to pay for the rest or structure such a change.
This temporary solution has already drawn criticism from physician organizations, which claim that, once again, Congress hasn’t gone far enough to address the problem. “They didn’t come up with enough money to actually fix it,” or provide any blueprint on a long-term solution, said Lori Heim, president of the American Academy of Family Physicians.
Congress has stepped in each time to enact a temporary fix so that doctors won’t experience additional reductions to their Medicare payments, but the industry, facing yet another 21.2% cut to their payments in March, wants a permanent solution.
Some physician lobbyists believe the Senate, in freeing up the money, is trying to advance that goal. It’s not a full-blown fix, yet the language in the debt ceiling bill “is heading in the right direction,” said Gordon Wheeler, associate executive director for public affairs with the American College of Emergency Physicians. “To the extent they’re pursuing an incremental approach, it’s to produce a positive result,” he said.
But a long-term SGR fix is going to require more than an $82 billion startup fund. The money earmarked for an SGR fix in the Senate debt-ceiling bill would be the equivalent of freezing physician payment rates for the next five years, said Robert Doherty, senior vice president of governmental affairs and public policy with the American College of Physicians. “That is not nearly enough to pay for a complete repeal, which would cost more like $210 billion to $230 billion,” Doherty said.
Joseph Stubbs, an internist in Albany, Ga., and ACP president, views this latest Senate solution as just another patch. Staving off the cuts over the years has resulted in this $200 billion-plus debt, Stubbs said. Even if Congress provides some additional money to fix the SGR, this debt will continue to accumulate until lawmakers change the formula, he added.
The Senate’s debt ceiling bill has yet to clear the House. If the Senate’s position prevails, “then Congress would either have to find additional offsets somewhere else to cover the difference, or they likely would be limited to another temporary measure” to stave off physician payment cuts, Doherty said.
Even if the legislation becomes law, Congress still faces the additional chore of approving legislation to address the actual problem, Doherty said. While the House managed to approve a bill late last year that fixes the problem, attempts in the Senate have failed.
What physicians don’t want is another temporary patch, Doherty said. The ACP, American Medical Association and other groups “will continue to do everything possible to push for full repeal,” he said. The AMA declined to comment for the story.
Wheeler wouldn’t speculate on how Congress might proceed. “It’s the toughest game in town” to figure out what the lawmakers will do on this chronic payment problem, he said. “The important thing is to get the SGR fixed.”
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.