Lawmakers Seek SGR Alternatives, But Who Will Pay?

"The first step towards reforming the Medicare payment formula is to immediately eliminate the SGR and set a realistic budget baseline for future Medicare payment updates, which fairly reflect the costs of providing quality health care, preserving the patient-physician relationship and ensuring patients have continued access to the physician of their choice," Hoyt told the subcommittee.

It is terrific that there are specific alternatives now on the table for Congress to complete. But there is still is the big question, one that will be wrapped in much politics, certainly. What about the $300 million cost?

 And these physician groups are seeking at least three years of stability while they examine potential payment models or try them out. Stability?

 "How do you get to that period of stability?" Salgian says, repeating my question. "Frankly, it's going to cost some money. Somebody is going to have to invest in real money, not small money, that each year hides the problem."

During that period of "stability" without the SGR, "we can test some models to replace the SGR. We can't put the resources appropriately if we are still fighting these cuts year after year," Salgian says.

"Everybody agrees it's a problem. Everybody agrees we've got to find a solution," he adds. "Everybody agrees this is not a long term solution, but when it comes down to paying for it, that's the problem we have."

Sen. Kent Conrad, D, ND, chairman of the Senate Budget Committee, has indicated that he would include a "doc fix" proposal as part of a 2012 budget plan. A spokesman for Conrad says there was no timetable for release of the plan although many expected it this week.

Lately, the discussion in Washington has centered on temporary "doc fix" legislation, but that's not exactly the permanent solution that the physician groups seek, as I see it.

With a couple of congressional committees potentially exploring the SGR issue, Salgian expects a "little bit of turf" battles.