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SGR Ripe for Repeal, Where's Congress?

Joe Cantlupe, for HealthLeaders Media, May 9, 2013

"Aligning clinical data with improvements to claims data is the most robust path toward true quality improvement," David Hoyt, MD, FACS, executive director of the American College of Surgeons, said in testimony before the health subcommittee.

While Congress is examining specific bills and probably a five-year value-based transition plan from the SGR, no one is embracing a specific plan, and the funding possibilities are uncertain.

"My hope is that we can put the days of kicking the SGR can down the road behind us," Brady said, using the most-favored cliché for this slow-burner of an issue.

Not even the determined Ways and Means subcommittee was able to move the issue forward. It held three hearings on improving the Medicare physician payment system last year, trying to provide a framework for change. Anders Gilberg, senior vice president of MGMA-ACMPE, (Medical Group Management Association-American College of Medical Practice Executives) told me that, indeed, the subcommittee "has seized upon the reduction, and there is an impetus to try to do something this year, replacing the SGR."

But, Gilberg asks: "With what?"

One of the things MGMA-ACMPE has been working on is what Gilberg calls a "glide path" from the SGR formula, which Gilberg also believes may take five years to test. "This isn't one size fits all," he says. "Primary care physicians aren't going to like bundling payments like a surgeon. We need to repeal the SGR, leave our options open, and get physicians into quality models."

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2 comments on "SGR Ripe for Repeal, Where's Congress?"


michael samms (5/10/2013 at 10:13 AM)
We need a system to address artificial demand creation. Programs addressing quality are always appropriate, but take a long time to widely implement. In the meantime, we need an immediate and effective reimbursement process that will eliminate up to $100 Billion in excess diagnostic services annually. A reimbursement program to slow cost increases will go a long way toward addressing needed reforms and will have an immediate payback. We need Wal-Mart style supply/demand economics which will alleviate the cost concern. Where is Wal-Mart or an organization that will step up?

msamms (5/9/2013 at 5:20 PM)
Artificial demand creation rules current healthcare economics. We could save $100 Billion annually with a proper structure. We need Wal-Mart style supply/demand economics. Begs the question, where is Wal-Mart on healthcare? Perhaps a different question: Who resides outside the current healthcare box and can save the U.S. healthcare system?