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Don't Count on SGR Reform This Year

Joe Cantlupe, for HealthLeaders Media, May 31, 2012

Under the current SGR structure, Medicare physician payments would be reduced 30.9% on Jan 1, 2013, unless, of course, Congress can be counted on to stop it—which they have continually done, in a one-step, two-step for years. The ongoing threat of reduced payments, while the physicians groups' payment needs increase each year, destabilizes their business operations and planning, as long as the formula stays in place.

On the surface, the mere focus of the letter on the SGR suggests immediate hope.

Don't believe it, insiders say.  It's probably illusory.

SGR reform absent from GOP's agenda
For one thing, it's summer and it's an election year—a double deal-breaker for advancing issues in Washington. Absolutely nothing will happen regarding the SGR, not for months, or possibly this year, I am told.  In addition, Republicans have a different healthcare focus, not the SGR: The GOP priority is getting rid of "Obamacare."

That push is reflected in a separate Washington D.C. document making the rounds. It's a memo from Rep. Eric Cantor, (R-VA), the House majority leader, sent to his GOP colleagues over the Memorial Day weekend. I received a copy. It makes no mention of SGR.

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1 comments on "Don't Count on SGR Reform This Year"


DonS (5/31/2012 at 2:50 PM)
Another consideration for SGR repeal or at least bringing in stability to the Medicare PFS for 2013 and 2014 is the Medicaid parity component mandated under PPACA. And that, of course, is assuming the PPACA is still there come January 2013. But if state's Medicaid programs must pay Medicare rates to primary care on E&M codes in January 2013, Congress can't be diddling around with SGR cuts, patches, fixes, or other nonsense into 2013 like they did in 2010.