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WASHINGTON – Once again, Congress will likely scramble at year’s end to make a last-minute decision on the Medicare Sustainable Growth Rate formula, Rep. Michael Burgess (R-Texas) said at a forum on physician payment.
Although the House Energy and Commerce committee passed an SGR replacement bill in July, the Senate Finance committee is slated to make final changes its proposal by early December, said Rep. Burgess, an ob.gyn.
Rep. Burgess is the lead sponsor of the Energy and Commerce Committee bill, the Medicare Patient Access and Quality Improvement Act of 2013. If enacted, that legislation would replace the SGR with a 0.5% payment increase for physicians from 2014 through 2018. It would continue to support fee-for-service medicine, but also encourage the formation of new delivery models and reward reporting of quality data.
Alicia Ault/IMNG Medical Media
Rep. Michael Burgess
The December timeline in the Senate "is going to push us pretty close to the deadline, and that’s once again a very uncomfortable place to be," he said, adding that the House is scheduled to recess on Dec. 13.
Even if the Finance Committee approves its proposal, which was developed with the House Ways and Means Committee, the legislation would have to be reconciled with the Energy and Commerce bill. One key difference: The Finance/Ways and Means proposal would freeze physician payments for 10 years, which physician groups oppose.
Any final bill would then have to be approved by both the full House and full Senate – all of which would have to be accomplished before year’s end, since the SGR calls for a 25% cut in Medicare fees on Jan. 1. The tight timeframe raises the specter of a temporary deal – or a patch – to avoid the cut.
"A patch would look a lot like the opposite of success to me," Rep. Burgess said. He added that "as long as we are moving in the right direction, I won’t say no to a patch."
He said that he would not approve of such a deal if it was struck solely because Congress had not worked hard enough to achieve a meaningful SGR replacement.
Rep. Burgess noted that the cost of repeal – estimated at $150 billion to $200 billion over 10 years – is about the same as is already being spent each year just to avoid the statutory cuts.
Congressional leaders have yet to discuss how to pay for an SGR fix, he said, because they want to first develop a policy on which legislators, doctors, and the Centers for Medicare and Medicaid Services can agree. He acknowledged that finding a funding mechanism would be painful but should not derail SGR replacement efforts.
Figuring out how to reform physician payment going forward remains a thorny issue, according to congressional staff members at the forum.
Legislators understand from their constituents that many physicians aren’t ready to move away from fee-for-service medicine, so they have been wrestling with how to create incentives to embrace alternative payment systems and quality measures.
Staff members urged physicians to unify around the proposals in front of Congress now. "It’s awfully important for the physician community to say ‘we actually like this, we think this works, we think we should do this,’ " said Dan Todd, who works on the Senate Finance Committee’s Republican staff.
Getting the final bill right is critically important as well, said Amy Hall, who works on the House Ways and Means Committee’s Democratic staff. "We don’t want to be back here in 5 years repealing the SGR repeal bill."
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