Physician Groups, Lawmakers Call for Repeal of SGR

Physician groups converged on Capitol Hill this week to weigh in on solutions to the untenable Medicare physician payment formula, according to a report in the Wall Street Journal.

The Sustainable Growth Rate (SGR) formula ties the rate of Medicare reimbursement pay to the U.S. gross domestic product, which has grown at roughly half the pace of healthcare spending over the last decade. To prevent steep cuts in physician reimbursement rates, lawmakers have repeatedly delayed the implementation of the SGR since 2002, in what has become known as the “doc fix.” If Congress doesn’t make changes to the formula by Jan. 1, 2012 -- or put off dealing with the issue again — physician Medicare reimbursements will be cut by almost 30%.

Speaking before the House Energy and Commerce Subcommittee on Health Thursday, Rep. Michael Burgess, MD (R., Texas), said, "Let's all accept the premise that SGR has to go. We need a permanent solution that is reasonable, updatable, and only that will do."

But according to a report in the Fiscal Times, Rep. David Camp (R., Mich.), who is chairman of the House Ways and Means Committee, said that finding $300 billion needed for a 10-year doc fix “was untenable in the current situation,” citing the $1.5 trillion federal budget deficit. Instead, he suggested lawmakers consider a “several-year fix . . . to get out from under this, and then look to the long-term fix,” the Times said.

Representatives of the American Medical Association (AMA), the American College of Surgeons (ACS) and the American Academy of Family Physicians (AAFP) and others presented their own recommendations on how to fix the Medicare reimbursement system. All of the physician groups called for a wholesale repeal of SGR.

The AMA suggested a “five-year period of stable Medicare physician payments that keep pace with the growth in medical practice costs,” according to the Journal. The organization also called on the government to accept balance billing, where physicians are permitted to bill Medicare beneficiaries more than the amount covered under the government program, according to the Journal.

The AAFP recommended a transition over five years to the patient-centered medical home model, the Journal reported. The group also wants primary-care physicians reimbursed at a higher rate than other specialties and boost incentives included in the healthcare reform law to combat physician shortages.

The ACS wants lawmakers to set a “realistic budget baseline” for future payment increases, which should “fairly reflect the costs of providing quality health care and are sufficient to preserve the patient-physician relationship and ensure patients have continued access to the physician of their choice,” according to the Journal.