MEDICAL ECONOMICS
SGR death throes? Congress moves closer to Medicare pay fix
BY AMY LYNN SORREL Congress appears closer than ever to re- placing what both physicians and lawmakers agree is a broken Medicare physician payment system, as legislative proposals in the U.S. House and Senate take shape. While physicians welcome the attention — and the leadership of some Texas congressmen — they are not exactly holding their breath. After all, Congress’ track record over the past decade isn’t exactly stellar, says Manuel Acosta, MD, a general surgeon in El Paso and chair of the Texas Medical Association’s Border Health Caucus. Instead of taking action, the federal government has pushed off a double-digit im- pending Medicare pay cut every year since 2003 and raised doc- tors’ pay no more than 2 percent — well below what it costs phy- sicians to provide the care. The scheduled reduction for Jan. 1, 2014 — now at roughly 25 per- cent — stems from what Dr. Acos- ta describes as a flawed Sustain- able Growth Rate (SGR) formula that fails to keep up with the cost of care and deters doctors from caring for senior patients. With roughly 80 percent of his patients in Medicare and Medic- aid, the low pay rates and uncer- tainty over the years have meant he, like many doctors, had to borrow money to stay in business, particularly in his border town, where doctors treat a higher percentage of low-income elderly patients with complicated conditions. “Somebody has to see these patients, but there will be a moment when nobody will because of the amount [Medicare] pays.” In fact, the percentage of Texas physicians accepting all new
Medicare patients dropped from 78 percent in 2000 to only 58 percent in 2012, according to TMA’s latest survey. TMA leaders find the latest reform efforts encouraging, but
remain cautiously optimistic as details emerge. A draft bill by the House Energy and Commerce Committee is the most substantive to date and has garnered bipartisan support. Instead of just delaying the inevitable annual pay cut,
“Somebody has to see these patients, but there will be a moment when nobody will.”
HR 2810, the Medicare Patient Access and Quality Improve- ment Act of 2013, creates a two-phase plan to eliminate the SGR and provide five years of stable fee updates. It then transi- tions to a new quality reporting system that links physician pay to a set of physician-endorsed quality measures, while allow- ing doctors to opt into alternative payment models. Bill supporters reached their goal of passing the measure out of the Energy and Commerce Committee and sending it on to the full House of Representatives by the Aug. 1 recess. Meanwhile, the Senate Finance Committee has held several hear- ings on the topic as it develops its own draft. Those efforts have so far overshadowed a similar bipar- tisan proposal reintroduced ear- lier in the year by U.S. Reps. Al- lyson Schwartz (D-Penn.) and Joe Heck, DO (R-Nev.), but that bill, the Medicare Physician Payment Innovation Act, nevertheless pro- vides yet another sign of political will to address the issue. The interest is driven largely by the slashed price tag on repeal- ing the SGR. The Congressional Budget Office (CBO) estimates that cost at $138 billion over 10 years — just over half the $244
billion it would have cost in 2012 and still below the roughly $150 billion Congress already spent to preserve the formula with short-term patches. Dr. Acosta says TMA and the Border Health Caucus con- tinue to meet with representatives locally and in Washington. While lawmakers are receptive to physicians’ plea for a fix, Congress has used a Band-aid approach for so long that “I don’t know yet if [these proposals] are going to be the answer. The answer will be fair payment for what we do.” U.S. Rep. Michael C. Burgess, MD (R-Texas), is vice chair of the House Energy and Commerce Health Subcommittee and one of the bill drafters along with U.S. House Ways and Means Health Subcommittee Chair Kevin Brady (R-Texas). He acknowledges that “physicians have been burned so many
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