Rep. Michael Burgess (R-TX) said on Wednesday that he will submit legislation this week to delay for one year the implementation of the sustainable growth rate formula (SGR). Without the delay, or other action, physicians face a 28% cut in Medicare reimbursements in January 2013.
Burgess made the announcement at a meeting of the House Energy and Commerce Committee called to discuss innovations to reform Medicare physician payments.
He said that the SGR delay would allow Congress to get past the uncertainties presented by the upcoming elections, the expiration of existing tax policy, the extension of unemployment insurance, as well as potential debt limit debates.
The SGR formula was put in place as part of the Balanced Budget Act of 1997 to help control Medicare spending. It soon became apparent that significant cuts in physician reimbursements would be required to help reduce spending but since 2003 Congress has routinely declined to make those cuts.
In 2011, SGR was the focus of the debt reduction debate. Although stakeholders and others supported its repeal, Congress instead enacted a series of short-term extensions before finally agreeing in early 2012 to delay the SGR implementation through 2012.
Although Burgess didn't specifically mention the lame duck status of Congress after the November election, he did characterize December as "an uncomfortable month for so many reasons. We know we aren't likely to end up doing something that provides long-term relief with a long term replacement for the SGR by Dec. 31."
Burgess, who practiced medicine as an OB/GYN before he was elected to Congress in 2002, noted that during the last round of SGR discussions earlier this year he and other members of the House had supported a two-year extension but settled for the one-year extension.
He said his proposed delay would "give us the time we originally wanted" to allow House Energy and Commerce Committee members time to "fully vet and evaluate" SGR replacement proposals and present them to physicians across the country for feedback.
Reaction among the committee members and witnesses scheduled to speak before the committee was mixed. Rep. Henry Waxman (D-CA) stressed that he wants to see something permanent happen to the SGR this year. "This problem needs to be resolved and not just kicked down the road. We need to get on with the job of doing what is responsible."
Rep. Frank Pallone (D-NJ) appeared receptive to an SGR delay. "We all agree that the SGR needs to be replaced. Is there political will to do that? Can it be done effectively by the end of the year with all these other problems that need to be addressed?"
Pallone asked how Rep. Burgess would pay for the extension and suggested that the large "pay for" could be covered by raiding the funding for overseas contingency operations (OCO), which are the discretionary funds used for the wars in Afghanistan and Iraq. The idea is popular with groups like the American Medical Association and has gained some traction in Congress although several Republican members of the committee made it clear that they would not support such a move.
"You're not going to use OCO money," stated John Shimkus (R-IL). "That's not going to happen."
Pallone said his Republican colleagues could forget trying to take funding away from the Patient Protection and Affordable Care Act to fund the SGR delay. "It's useless politically to try to do that." He added that taking funding away from other parts of the healthcare system also isn't the answer. "The healthcare system is in crisis and other healthcare providers share the same problems as physicians."
In an e-mail exchange after the committee meeting Bob Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians, said Congress "shouldn't decide now that an extension is the best it can do. The goal should be to enact legislation that eliminates the SGR and begins the transition to a better payment system."
He said the group supports the Medicare Physician Payment Innovation Act (HR 5707) because it makes progress toward that goal.
The delay proposal by Rep. Burgess seemed to catch by surprise the witnesses, who were there to tout various payment innovations to the House committee. The witnesses, who represented insurers and physician groups, all stated their support for repeal of the SGR but didn't directly address the Burgess proposal.
Physicians advocates have asked Congress for alternatives to the payment scheme.
See Also:
Physicians Weigh In on SGR Debate
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
