Physicians Take SGR Repeal Message to Washington

As physicians convene for the AMA's annual advocacy conference, President Ardis Dee Hoven, MD, says she remains optimistic that Congress will pass legislation to repeal the Sustainable Growth Rate formula, despite the lack of a clear funding plan.

With Congress facing an end-of-the-month deadline to repeal the reviled Sustainable Growth Rate, hundreds of the nation's physician organizations on Wednesday intensified their calls for a permanent fix for the funding formula.

Ardis Dee Hoven, MD, president of the American Medical Association, said that more than 600 state and national physicians' organizations sent a joint letter to House and Senate leaders on Wednesday asking them to repeal SGR before the latest temporary delay lapses on March 31 and a mandated 24% cut in Medicare reimbursements kicks in.

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 are being asked this week to personally contact their members of Congress and urge them support the legislation, HR 4015 and S 2000, that would repeal the SGR formula and create what the AMA calls "a pathway to developing and implementing new healthcare delivery and payment models to improve the quality and effectiveness of care."

Even with the clock ticking, Hoven told HealthLeaders Media Wednesday that she is optimistic that Congress will get the job done.

AMA: Momentum 'Gathering'
"We continue to be very enthusiastic about repeal," she says. "Clearly the momentum has been gathering over the last several months and we now have a piece of legislation with bicameral bipartisan support that has been supported aggressively by the physician community and has been met with great support by members of Congress on both sides of the aisle, which goes to the intent and energy that has been committed to this. The challenge we have now is that there is a time crunch."

"Sometimes they do their best work when there are deadlines facing them. There has been a lot of energy and effort put into this by members of Congress already. We are encouraging them to keep up the conversations and bipartisan work that they have demonstrated they can do on the policy piece of this. So there are great opportunities there, she said"

The legislation repealing SGR appears to have widespread and bipartisan support in both the House and Senate. Hoven said that Congress has spent $153.7 billion on 16 previous legislative patches to the SGR formula, far more than the Congressional Budget Office's $138 billion estimate for the cost of a permanent fix over 10 years.

Seeking Pay-Fors
Hoven concedes, however, that the challenge now is finding a way to pay for the repeal.

"The AMA understands there are diverging opinions about where the pay-for should come from," she says. "Congress has a large menu of pay-for opportunities that CBO has presented to them. We are simply now waiting to understand where these pay-fors will come from."

Nicholas Manetto, a healthcare policy consultant and director at FaegreBD Consulting, says it's difficult to determine whether Congress will be able to repeal SGR by the end of the month.

"That is the $64,000 question," he says. "There is a lot of agreement on the core policy and the provisions of the legislation, but now the biggest question out there is really what's the final price tag and how is it going to be paid for?"

While there are any number of ways to find cuts in the federal budget to pay for the SGR repeal, Manetto says the trick is to move quickly once a set of cuts are identified and agreed upon.

Another Patch?
"The longer your pay-fors sit out there exposed, the more you are like a sitting duck," he says. "You are going to give the opposition time to marshal and rally the troops."

Manetto says the chances of passing a permanent SGR repeal grow slimmer with each passing day, as members of Congress look to wrap up business and head home to run for reelection.

"The more time that goes on absent progress in that direction, the more likely you are going to need another temporary patch and then the question is going to be what will that look like," he says. "Will it be short term, or do they try to do something longer, and really how do you get anything done this year on the longer term?"

Hoven is not entertaining thoughts about potential contingency plans if this latest SGR permanent repeal attempt fails.

"Right now all we are going to talk about is SGR repeal," she says. "Clearly the opportunity exists to get this done. I believe strongly it can be done. Our job right now is to make sure that members of Congress understand the importance of getting this repealed."