With the clocking ticking down to the point where Medicare will have no choice but to start implementing the 21% SGR cut, Congress still has not been able to agree on a solution. The House has passed a short-term, 19-month fix that will replace the cut with positive updates through 2011. The Senate has yet to act on the House’s bill or decide on its own alternative.
Part of the problem, though, is that physicians are not united on what they want. Although everyone in medicine agrees that we want the SGR repealed and replaced, the simple fact of the matter is that there is no way to get 60 votes in the Senate (or for that matter, a majority in the House) to vote for repeal when the price tag is over $230 billion—money which would have to be found by cutting Medicare somewhere else, reducing Social Security benefits, or raising taxes under pay-as-you go laws.
ACP’s position has been that if Congress decides on an approach that falls short of repeal, it should at least provide more stability than 19 months, and it should begin to move payments to a better framework that could be the basis for eliminating the SGR in subsequent legislation. With ACP’s support, House and Senate leaders, just a few weeks ago, were hoping to get agreement on a plan to provide five years of stable updates, during which payments for the last three years would be based on a new formula that would allow physician services to grow at a higher rate than the SGR, with an additional growth factor for primary care visits and preventive services. This approach was abandoned, in part, because it did not have across-the-board support within medicine. The House then proposed a similar approach, but for only three-and-a-half years. When that failed to attract enough support, the House came up with its 19 month fix.
Now, the Senate is considering offering an amendment to go back to the House’s idea of a three-and-a-half year plan that would begin to move policy in the right direction. ACP expressed support for the plan, in a letter to Senator Debbie Stabenow (D-MI), the likely sponsor of the amendment. The American Academy of Family Physicians and American Osteopathic Association also support it. But its prospects remain uncertain, at least in part, because not all of medicine is rallying behind it, and some Senators are still unwilling to commit to anything that has a practical chance of stopping the cut and moving payments to a better system.
We all want SGR repeal, but at some point, the question becomes a simple one. Do we go along with another 19-month patch that does nothing to move to a better system? Or do we rally behind a plan to provide longer-term stability that also begins to move us to a better payment structure, one that would allow spending on all physician services to grow at a higher rate than the SGR and provide an additional spending growth allowance for primary care visits (including visits billed by subspecialists) and preventive services code? Or do we say we can only support complete repeal , when there aren’t the votes for repeal, and we likely will then end up either with the cut, or a short-term patch that does nothing to move to a better payment system?
Today’s question: What would you choose?