Tis the season again of crowded mall parking lots, crowded big box stores, holiday office parties and discussion of permanently fixing the “sustainable growth rate” (SGR) permeating Congress. Many media reports now of strong, bipartisan support to permanently fix the SGR, largely, because the estimated cost of doing so is going to be a lot cheaper now according to new estimates – up to $34 billion dollars cheaper.
Nonetheless, the fix won’t be on before Santa arrives again and months-long extensions will be needed before a deal can be struck. One more patch and finding ways to offset the costs while the AMA reserves judgement before we will know for sure what this means.
The AP (12/11, Alonso-Zaldivar) reports that both Democrats and Republicans now favor a permanent change to “Medicare’s broken physician payment policy,” known as the “sustainable growth rate” (SGR) and are working towards a new system that would contain “financial carrots and sticks for doctors to provide quality, cost-effective care” for Medicare patients, with “up to 10 percent of an individual physician’s pay” connected to “quality indicators.” This week, the Senate Finance Committee is expected to take up “a broad bipartisan framework” on the matter which will also be taken up by the House Ways and Means Committee. Yet, Congress will still have to adopt a “temporary patch” for early 2014, as no one expects agreement on a plan before the beginning of the year. The biggest obstacle to that is the need to find “offsets” to the cost of the temporary fix. As to the permanent fix, the AMA is said to be “reserving judgment.”
The National Journal (12/11, Ritger, Subscription Publication) reports that one reason why a permanent repeal of the Sustainable Growth Rate seems likely is that the cost over ten years has now fallen according to the CBO from over $150 billion to $116.5 billion. Still, it “won’t happen before the holiday recess.” One version of a permanent replacement, attributed to the House Ways and Means committee, would adjust physicians’ payments, starting in 2017, “based on four performance metrics: quality of care, budget-neutral resource use, meaningful use of electronic health records, and clinical-practice improvement activities.”
The Hill (12/10, Viebeck) reports in its “Healthwatch” blog that a three month patch is expected.
CQ (12/11, Ethridge, Subscription Publication) reports that both Senate Finance and House Ways and Means committees are expected to take up permanent plans tomorrow, but have not “announced plans to bring a short-term patch to either chamber’s floor.”
The American Medical Association (12/11) “Tuesday announced its support for the bipartisan, bicameral legislative proposal scheduled for committee markup this week.” It would “eliminate the SGR formula.” AMA President Ardis Dee Hoven, MD, said that the association is “urging the senators to ‘maintain constructive progress for reforming the Medicare physician payment system’ and favorably report the bill out of committee.” The AMA cites other “notable benefits of the draft legislation” including: consolidation of “existing Medicare reporting programs;” “bonus payments” for “high-performing practices;” reduced penalties for not participating “in quality reporting;” and retention of all funds in “the physician payment pool.” Dr. Hoven said, “The current proposal is a significant improvement over current law and will result in a stronger Medicare program for both patients and physicians.”