Doc Groups Respond Over Proposal to Extend SGR Delay Three More Years

Several major medical groups are expressing mixed reactions about a congressional proposal to delay a 21% cut in Medicare reimbursements when the latest exemption to the sustainable growth rate payment cut runs out June 1. Under the measure inserted in HR 4213, the "American Jobs and Closing Tax," the SGR cut in Medicare payment would be delayed until 2014.

As proposed, the measure calls for a 1.3% increase for physicians beginning June 1, followed by a 1% payment update starting Jan. 1, 2011. For 2012 to 2013, the bill would use new payment targets from another bill (HR 3961), which passed the House last November: one would provide a conversion factor based on the gross domestic product, plus a 2% increase for primary care and preventive health services, while the other has a conversion factor of the GDP plus a 1% increase.

By 2014, the payment formula would go back to the SGR. A move earlier this week in Congress to stall the cuts for five years was dropped. A vote on the provision is expected in the House and Senate the last week of May.

Congress' move to delay "a looming Medicare physician payment cut will provide temporary stability for seniors and their physicians," said American Medical Association President J. James Rohack, MD, in a statement. However, the organization was "deeply disappointed that Congress will once again fail to permanently correct the Medicare physician payment formula that Republican and Democrat members of Congress, President Obama and policy experts have said should be repealed."

Writing in his blog on Friday, Rohack said that the newest proposal "treats the symptoms—it's not a cure for the disease" and that "Congress must act well before the next deadline to fix this problem once and for all to preserve access to care."

In his prepared statement, Ted Epperly, MD, board chair of the American Academy of Family Physicians said the new payment provision in HR 4213 "recognizes the importance of allowing for growth in the services provided by primary care physicians, especially if we are to respond to the increased demand for these services as more Americans get covered by insurance."

"The data are clear that healthcare based on primary care will be both more efficient and more effective," Epperly said. The pending legislation "builds on the recent efforts of Congress to recognize the value of primary care and provides stability of payment for several years."

"While we are disappointed that the bill does not provide the permanent payment reform that we and the physician community have been seeking, it takes a step in the right direction," Epperly added. "We will continue to work with Congress to find a permanent payment formula that includes the precedent of improved and differential payment for primary care physicians."

Noting opposition to the proposal earlier this week in the Senate because the payment formula was not paid for through reductions in spending or increases in revenues, AAFP is calling for its members to contact their senators to tell them to ensure the pending 21% reduction does not go into effect on June 1.

American College of Physicians President J. Fred Ralston, Jr., said that ACP was "particularly pleased" that for 2012 and 2013 the update for all physician services will be "held to a growth rate that is higher than the current SGR formula" and that "an extra allowance for primary and preventive care" will be included, with a statutory guarantee that payments could not be reduced in 2012 or 2013.

However, "permanent repeal of the SGR remains essential," Ralston said. "We are committed to working with Congress to ensure that a new payment framework, including more appropriate spending targets for all services and increased allowances for primary care and preventive services, is permanently enacted into law before payments revert to the current law formula in 2014."

American College of Cardiology President Ralph Brindis, MD, said that while his organization will continue to "push for a permanent payment solution," they are encouraging the House to pass the "SGR improvements."

“Four years of positive updates will provide physicians with the stability needed, while we look at real ways for true payment reform and eliminating the need for the SGR," he said.