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SGR Ripe for Repeal, Where's Congress?

Joe Cantlupe, for HealthLeaders Media, May 9, 2013

Physician groups say the time is finally right for lawmakers to overhaul the disdained sustainable growth-rate formula. But no one in Congress is embracing a specific plan, and the funding possibilities are uncertain.

The much-maligned sustainable growth rate formula is caught in the vise of what's known on Capitol Hill as "issue fatigue," an American Medical Association official in Washington D.C. told me recently. And that's a good thing.

Essentially, SGR is an issue that gets an airing in Congress every year, but members shout it down before anything gets accomplished. When this keeps happening, year after year, fatigue sets in among lawmakers. Eventually they conclude that something (anything?) must be done; otherwise it just will keep coming back.

Over the last several years, Congress has imposed the "doc fix" to ward off potential cuts in the SGR, which is scheduled to lower Medicare rates by 24.4% in 2014. The SGR sets Medicare physician payment rates through an economic rate formula set in 1997. Proposed cuts have prompted Congress to delay the cuts since 2002, but have essentially increased the price tag of yearly fixes.

"There is this issue fatigue on the Hill," said the AMA official, who did not want to be identified. "It's getting as bad for (Congress) as it is for all of us. Coming up with money for these short-term fixes is getting harder and harder. In the end, you fix this for a year and have the same problem the next year."

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2 comments on "SGR Ripe for Repeal, Where's Congress?"


michael samms (5/10/2013 at 10:13 AM)
We need a system to address artificial demand creation. Programs addressing quality are always appropriate, but take a long time to widely implement. In the meantime, we need an immediate and effective reimbursement process that will eliminate up to $100 Billion in excess diagnostic services annually. A reimbursement program to slow cost increases will go a long way toward addressing needed reforms and will have an immediate payback. We need Wal-Mart style supply/demand economics which will alleviate the cost concern. Where is Wal-Mart or an organization that will step up?

msamms (5/9/2013 at 5:20 PM)
Artificial demand creation rules current healthcare economics. We could save $100 Billion annually with a proper structure. We need Wal-Mart style supply/demand economics. Begs the question, where is Wal-Mart on healthcare? Perhaps a different question: Who resides outside the current healthcare box and can save the U.S. healthcare system?