Wednesday, February 15, 2012

Here they go again

Congress is expected to reach final agreement tonight on another "patch" to the Sustainable Growth Rate (SGR) cuts: 10 month continuation of current (2011) rates, followed by a 32% cut on January 1, 2013. In other words, the same old thing that Congress has been doing year-after-year, month-after-month: enact a patch that puts off a long-term solution. Even worse, the patch, like the others before it, will only make the next cut bigger (from 24.7% now to 32% on January 1). And, as the cut gets bigger, the cost to the budget of preventing it--and all future scheduled cuts--grows by tens of billions of dollars.

What is particularly difficult to understand is that Congress had an exit ramp this year from the whole SGR debacle. It could have used unspent money from overseas military operations that will never take place to prevent cuts from the SGR that Congress will never allow to happen. This would have produced more than enough money for Congress to fully repeal the SGR, without having to offset the cuts by goring someone else's ox. Just about every physician, hospital and seniors group had urged Congress to take this exit ramp but in the end, it decided to stay on the same familiar path of putting off the solution (and finding the money for it) to another day, another time.

To be fair, there were some members of Congress, Republicans and Democrats, who urged their colleagues to use the unspent operations money to get rid of the SGR, once and for all, but unfortunately, they didn't carry the day.

Where does this leave organized medicine? I expect it will fall to a post-election, lame-duck session of Congress to come up with a plan to eliminate the January 1, 2013 SGR cut, as well determining the future of the Bush tax cuts (also expires at the end of the year) and across-the-board budget sequestration cuts scheduled for 2013. ACP will continue to push for a permanent solution as the only right thing to do--but I wouldn't bet on it.

Some of you will no doubt want to blame one political party or the other. But the fact is that an institutional failure to enact a permanent solution to the SGR has been the legacy Congress' and administrations stretching back to 2002, the first time an SGR cut went into effect, no matter which party was in control at the time.

And some of you no doubt will blame your professional organizations for Congress not enacting a permanent solution. Criticism is fair game, and I would welcome ideas on what we might do differently next time. But other than taking steps that violate physicians' own professional ethics, like organizing strikes and boycotts, I can't think of what we might have done or do differently.

Today's question: What will you say to your members of Congress about the latest SGR patch?


Arvind said...

This is precisely what was expected. Why did we even think SGR would be done away with? Illogical.

This a legacy of the Clinton administration. So we cannot blame the last two administrations of it.

What we could have done? We could have insisted that our support for ACA would be 100% dependent on repeal of SGR. Once that did not happen, we (ACP) could have officially dropped our support of the ACA and canvassed for its repeal. Alas, we are asking these questions now, a full two years after the passing of Obamacare.

So let the cuts go through and let the chips fall where they may. Then each practice can decide on Medicare participation. And Medicare beneficiaries can storm the White House and Congress.

Harrison said...

I kind of agree with Arvind on this one.
Except that I think the ACA was a good piece of legislation in its own right.

But as far as what to tell legislators...maybe just tell them to be honest.
If they don't see repeal and replacement of the SGR as important, then stop playing the ridiculous game and have the political courage to support the cuts.
Or have the political courage to repeal and replace.

Stop the ridiculous accounting gimmick.