The President’s Podium: Getting Closer to a Medicare Payment Fix

by Ronald Dunlap, M.D., President, Massachusetts Medical Society

Mention “SGR” to physicians and you can almost see and feel the tension and level of frustration.

For nearly a dozen years, this Sustained Growth Rate formula has called for massive cuts in Medicare reimbursements to physicians.  For each of those years, Congress has stepped in at the eleventh hour to avoid the cuts and provide a modest increase. Yet, for all those years, physicians worried about the viability of their practices and their patients.  And patients, having read and heard media reports about the possibility of physicians abandoning Medicare because of potential cuts in payments, may have wondered if they would continue to have a doctor.

We’re now closer to a permanent fix than ever before. On the last day in July, the House Committee on Energy and Commerce reported the “Medicare Patient Access and Quality Improvement Act” by a unanimous vote of 51-0. That bill repeals the SGR and replaces it with annual updates and new quality incentive measures.  Adding to the hope of a fix is a report from the Congressional Budget Office that estimated the cost to eliminate the SGR formula at about half the price of repeal last year.

However, two additional committees, House Ways and Means and Senate Finance, are scheduled to produce their own versions of the legislation, which will likely be combined and then brought to a vote in both the House and Senate.

While the 51-0 vote and CBO report raise hope, the work is far from done. Many key issues remain to be resolved, among them the adequacy of the proposed increases, the complexity of the new quality reporting system, and provisions for small practices that will allow them to maintain their viability and keep their doors open for their patients.

The AMA, in an effort to keep the momentum going, has launched Fix a website with three distinct channels: one each for physicians, patients, and policymakers, allowing each a voice on the subject and the ability to participate in the discussion.

The Massachusetts Medical Society, with the participation of many of our district presidents who have written letters to the editor to newspapers and media outlets across the state, has encouraged our Senators and Congressional representatives to make these changes a priority for Congress and finally reach a reasonable “fix” for a problem that has long plagued physicians and patients alike.

A new and better payment formula and better quality measures will help to stabilize Medicare for years to come. It will ease the minds of Medicare and Tricare patients in knowing their doctors will be there for them.  We’ve never been closer to fixing a broken system. It is imperative that physicians and patients alike maintain the momentum by urging Congress to capture the opportunity before them.

The President’s Podium appears regularly on the MMS Blog and offers Dr. Dunlap’s commentary on a range of issues in health and medicine.


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