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Don't Count on SGR Reform This Year

Joe Cantlupe, for HealthLeaders Media, May 31, 2012

"Given the SGR situation and the long-term fiscal challenges faced by the Medicare program, this committee recognizes the urgent need to transform Medicare's physician payment system to one that preserves and promotes the patient-physician relationship and rewards physicians for the high-quality and efficient care they provide," says the committee's April 27 letter to physician groups.

"Experts agree that there is no 'one-size-fits-all' solution and that a reformed payment system will require some flexibility to account for the diverse needs of both beneficiaries and physicians," the letter adds. "As we continue to work toward a permanent, fiscally responsible solution for the SGR, we are seeking input from the physician community and other stakeholders."

Short-term fixes result in deficits
The committee noted that Congress has repeatedly enacted legislation to avert scheduled rate cuts since 2003.  It also said that the short-term fixes have resulted in deficits of $300 billion over the past decade.

In response to the House Ways and Means Committee letter, American Medical Association  CEO James L. Madara, MD, pointed to payment rules under Medicare Part A and Medicare Part B that have "not adapted to the increased use of physician services vs. hospital services."  The AMA adds, "This imbalance creates disincentives for physicians who are working hard to provide the most efficient and efficient care for their patients."

An official of the AMA, who also declined to be identified, commented later on the letter, saying, "Eliminating the formula remains a top priority for the AMA and this letter is one step in working with Congress to see that goal achieved."  The official noted that the Senate Finance Committee had a roundtable discussion on the SGR in March.

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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.