Doctors continue to push for SGR repeal

When the Centers for Medicare & Medicaid Services announced the 2014 pay rates for physicians last week, the agency touted a final rule reflecting a shift to a greater emphasis on high-quality care and efficiency, but physician groups were unimpressed, instead keeping their focus on the sustainable growth rate issue.

“The Centers for Medicare & Medicaid Services’ final 2014 Medicare physician pay schedule indicates the country may slowly be moving in the right direction in establishing a health care system that meets patients’ needs for a usual source of care and a continuous relationship with a primary care physician,” said Reid Blackwelder, MD, the president of the American Academy of Family Physicians in a statement.

“But the AAFP is disappointed that current law continues to require CMS to issue a physician fee schedule that slashes payment by 20.1 percent next year. The schedule reflects the flawed sustainable growth rate formula that dictates Medicare payment for physician services. That formula must be repealed, and the AAFP urges Congress to act quickly to do so.”

The AAFP and other physician groups have been lobbying Congress to repeal the SGR for years. While many lawmakers have indicated they are amenable to repealing, no one has been successful in getting repeal legislation passed, largely because a viable plan for paying for it has yet to be developed.

Instead, each year as the cuts were about to take effect, Congress offered patches to hold off those cuts. This year’s cut, scheduled to take effect January 1st, is over 24 percent.

Physicians have argued and continue to argue, that the constant fiscal uncertainty leaves them in an impossible position, unable to make business decisions because they don’t know if they’ll be able to fund them, a point the American Medical Association made in response to CMS’ physician payment final rule and the agency’s emphasis on transforming to value-based payments. 

“The clock is ticking,” said Ardis Dee Hoven, MD, AMA’s president, in the statement. “At stake are innovations that would make Medicare more cost effective for current and future generations of seniors. These innovations are not possible if physicians are worried about drastic cuts to Medicare rates that have remained almost flat since 2001, while the cost of caring for patients has gone up by 25 percent.”

While many providers are hopeful this will be the year SGR is repealed, the chances of repeal are complicated by the looming end of the continuing resolution that is keeping the federal government open through mid-January.

However, in its favor is history, noted law firm Mintz Levin in a brief about the likelihood of a repeal of the SGR.

“The prognosis for an SGR overhaul to be included in a December/January deal to fund the government is strengthened by the experience, in the period following a government shutdown, of ‘big ticket’ legislative items moving successfully through Congress,” the firm wrote. After the 1996 government shutdown, the brief notes, lawmakers passed, for example, the Health Insurance Portability and Accountability Act, the FDA Export Reform and Enhancement Act of 1996 and the Telecommunications Act of 1996.