Another SGR Patch Likely, Lawmaker Says

Lawmakers can't agree on a way to plug the $122 billion hole in the budget that would be created by the elimination of the reimbursement cuts and "chances are not great" for a permanent fix by the March 31 deadline, says the co-chair of the GOP Doctors' Caucus.

Congress likely will not find a permanent solution for the Sustainable Growth Rate funding formula before the deadline expires at the end of March, and will impose yet another temporary fix and re-address the issue later this year, a leading House Republican says.

U.S. Rep. Phil Gingrey, MD, (R-GA) co-chair of the 19-member GOP Doctors' Caucus, says there is widespread support in both parties and both chambers for ending the SGR Medicare reimbursement formula for physicians. However, he says lawmakers can't agree on a way to plug the $122 billion hole in the budget that would be created over 10 years with the elimination of the reimbursement cuts.

"By the end of the month I would have to say the chances are not great. That would require another short-term patch. But before the fall elections is what I am hoping for. There is a lot of work to be done between now and then," Gingrey said in a telephone interview.

Pressed by the American Medical Association and other physicians' associations to find a permanent fix, lawmakers had talked about finding common ground. However, momentum appeared to stall with word that House Republicans are expected this week to pass a bill that would pay for the cost of eliminating the SGR with a delay of the individual mandate under the Patient Protection and Affordable Care Act. Gingrey says he expects the bill will pass the Republican-controlled House.

Calls to the office of Senate Majority Leader Harry Reid, (D-NV), were not immediately returned Monday, but Democrats in the Senate are not expected to support any bill that tampers with the individual mandate.

As a result, Gingrey says, another temporary fix, the 17th such stop-gap measure since the SGR took effect in 2001, likely will be enacted to avoid the mandatory 24% cut in Medicare reimbursements that would otherwise go into effect when the deadline expires.

"It's just the clock. I am afraid there is not time," Gingrey says. "We are going to pass it in the House this week. It goes over to the Senate. The following week is a district work period, but two weeks from this week it could come back to us amended and then the conference would begin. But by then you're at the end of March and the patch only lasts until March 30. So obviously if we are going to mitigate, and clearly we on the Republican side and I would think the Democrats as well, don't want the doctors to take a 24% cut to their reimbursements to Medicare. They wouldn't stay in the game if they do."

Anything short of a permanent fix would be the latest in a long string of disappointments for the American Medical Association and other physician organizations that have complained for more than a decade about the SGR and the anxiety and uncertainty it creates. Last week, the AMA and more than 600 state and national physicians' organizations sent a joint letter to House and Senate leaders asking them for a permanent repeal before the end of the month.

AMA President Ardis Hoven, MD said in a statement Tuesday, "As we inch closer to March 31st without a permanent fix to the flawed SGR policy, the AMA is disappointed that some lawmakers may be abandoning a bipartisan, bicameral solution in favor of adding to a growing budgetary problem of Congress' own making. Another stopgap measure to brace Medicare's troubled payment system simply wastes more taxpayer money to preserve a bad policy." 

As recently as December, Hoven expressed optimism that an SGR repeal was imminent.

The letter was sent as hundreds of physicians descended on Washington, DC, to take part in the AMA's annually national advocacy conference. In addition, physicians from across the country were asked to contact their members of Congress and urge them support the legislation, HR 4015 and S 2000, that repeals SGR formula and creates what the AMA calls "a pathway to developing and implementing new healthcare delivery and payment models to improve the quality and effectiveness of care."

Gingrey says that the House bill will move the process forward. What's important, he says, is getting into a conference committee with the Senate so that lawmakers can negotiate a solution.

"I am not going to get over the tip of my skis by saying what the pay-fors might be coming out of the conference committee," he says. "But we are very optimistic that we can get an agreement in conference and finally, after about 10 or 15 years of trying, to get rid of this flawed SGR formula [that] we can have a better payment system for our physicians so we keep them in the system accepting Medicare patients, which our precious seniors desperately need."