SGR Ripe for Repeal, Where's Congress?

Joe Cantlupe, May 9, 2013

Physician groups say the time is finally right for lawmakers to overhaul the disdained sustainable growth-rate formula. But no one in Congress is embracing a specific plan, and the funding possibilities are uncertain.

The much-maligned sustainable growth rate formula is caught in the vise of what's known on Capitol Hill as "issue fatigue," an American Medical Association official in Washington D.C. told me recently. And that's a good thing.

Essentially, SGR is an issue that gets an airing in Congress every year, but members shout it down before anything gets accomplished. When this keeps happening, year after year, fatigue sets in among lawmakers. Eventually they conclude that something (anything?) must be done; otherwise it just will keep coming back.

Over the last several years, Congress has imposed the "doc fix" to ward off potential cuts in the SGR, which is scheduled to lower Medicare rates by 24.4% in 2014. The SGR sets Medicare physician payment rates through an economic rate formula set in 1997. Proposed cuts have prompted Congress to delay the cuts since 2002, but have essentially increased the price tag of yearly fixes.

"There is this issue fatigue on the Hill," said the AMA official, who did not want to be identified. "It's getting as bad for (Congress) as it is for all of us. Coming up with money for these short-term fixes is getting harder and harder. In the end, you fix this for a year and have the same problem the next year."

Joe Cantlupe Joe Cantlupe is a senior editor with HealthLeaders Media Online.Twitter


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