AMA Pushes Lame Duck Congress for SGR Repeal

Efforts to repeal the formula by which Medicare reimburses physicians are being bolstered by a report from the Congressional Budget Office indicating lowered costs associated with rescinding the reimbursement cuts.

The American Medical Association wants the lame duck 113th Congress to permanently repeal the reviled Sustainable Growth Rate funding formula for Medicare before the session adjourns next month.

"It's important that we take advantage of the momentum that was created by all the worked that was done earlier this year to create HR4015 and Senate bill 2000," AMA President Robert M. Wah, MD, told HealthLeaders Media Tuesday, referring to the ill-fated legislation that failed to repeal the SGR last spring.

"The prevailing opinion is that everybody wants to get rid of this. They have the legislation in the form of these two bills to get it done," Wah said.

At the AMA's annual House of Delegates meeting in Dallas this month, Wah told attendees: "Congress must eliminate the SGR in the lame duck session. Why? Because it's essential to sustainable practice and preserving access… It might not happen during this lame duck session, but the end of SGR is not a matter of if, but when."

"All three committees of jurisdiction worked hard on creating a bipartisan bicameral bill that will work to end the SGR finally. That was done in such a regular and transparent way and each bill was reported out by the committees unanimously. We are hoping to capitalize on that work and that momentum and get this finally dealt with in the lame duck session we are currently in."

20% Cuts Loom
A 17th attempt at repealing the SGR—the top legislative priority of the AMA for the past decade—seemed on the cusp of reality in late March with broad support in both chambers. However, momentum faltered and lawmakers instead opted for another temporary fix that will expire on April 1, 2015. If that happens, physicians will see a more than 20% reduction in Medicare reimbursements.

Wah says the threats of massive reimbursement cuts and the annual sideshow surrounding an 11th hour temporary fix have left physicians anxious and frustrated.

"For the last several years it has been a close to 20% cut hanging over physicians' heads and it wasn't dealt with until the last minute," he says. "Not knowing what your revenue stream is going to be makes it very hard to plan or even think about any sorts of innovations."

CBO: Costs Have Dropped
Efforts to repeal the SGR may have been bolstered this month by a new scoring from the Congressional Budget Office, which lowered by $5 billion the estimated cost of rescinding the reimbursement cuts and freezing the reimbursements at $118.9 billion through 2024.

If an additional 0.5% in annual reimbursement increases is factored in, the cost of the SGR repeal would be $140.2 billion through 2024.

Nonetheless, paying for the SGR remains the biggest stumbling block. Wah says he's not going to make suggestions. "It is up to them to choose from the menu of options they have," he says. "Just like I wouldn't want them to tell me how to do surgery, I don't feel it's my job to tell them where to find financing for this legislation. It is the work of Congress to make those choices from the menu of options."

Wah says another failure by the 113th Congress to repeal the SGR likely means that the incoming 114th Congress will not have much time to address a permanent fix before the Medicare reimbursement cuts kick in on April 1, 2015.

"When Congress comes back in January and has to go through the reorganization and all of that business and reintroduce bills it will slow things down in our estimation," he says.

"We want to see something done in the lame duck session to capitalize the work that has been done and the momentum that has been created. This bipartisan bicameral bill was supported not only by Democrats and Republicans, but also by 600 physician organizations who contacted their representatives and senators to encourage them to pass this."