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Senate Finance Committee Hears More 'Doc Fix' Testimony

Margaret Dick Tocknell, for HealthLeaders Media, May 15, 2013

 "We should not simply repeal the SGR. We must also change the underlying fee-for-service system," Baucus added. He underscored the need for "concrete policies that can be implemented now to replace the SGR" and called on three experts "to help us identify short-term, ready-to-go solutions."

The three were Mark E. Miller, Ph.D., executive director of the Medicare Payment Advisory Commission, A. Bruce Steinwald, a consultant who formerly worked for the General Accounting Office, and Kavita K. Patel, MD, fellow and managing director of the Engleberg Center for Healthcare Reform at the Brookings Institute and a practicing physician.

The trio didn't precisely meet the chairman's directive, but each described potential SGR replacements−or at least concepts−that address some of the issues that have emerged during a series of Congressional hearings on the topic.

MedPAC to oversee legislated fee-schedule updates?
Increases in the Medicare population, the number of physicians reaching retirement age, and physician frustration with the annual doc fix could combine to strain beneficiary access in some markets. MedPAC's Miller suggested that it could be necessary to replace SGR with a 10-year schedule of low, legislated fee-schedule updates with MedPAC conducting an annual review of the payment rates and recommending changes.

The updates wouldn't be based on an expenditure- or volume-control formula. Instead, Miller explained, the updates "would allow total Medicare expenditures for fee-schedule services to increase annually—roughly doubling over the next 10 years."

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