As new year approaches, pleas to Congress to scrap SGR grow more urgent

Desperate times call for congressional intervention.

Such is the hope of physicians and the organizations that represent them during this intense period of seemingly never-ending physician payment cuts enacted by the Medicare Sustainable Growth Rate (SGR) formula. In an effort to expedite the process and convey the severity of the issue, the American College of Physicians (ACP) postmarked a three-page, three-step letter to both the U.S. House and Senate on Dec. 17 discussing the need to “create a permanent solution to the endless cycle of Medicare physician payment cuts.”

“Congress has a unique opportunity now, in the context of discussions on the ‘fiscal cliff’ and entitlement reform, to create a clear timetable and policy direction, resulting in permanent SGR repeal no later than next year, accompanied by a transition to value-based payment and delivery system reforms,” wrote David L. Bronson, MD, FACP, president of ACP, on behalf of organization heads and the 133,000 physicians they represent. “The Medicare SGR formula acts as the greatest single barrier to transition to new approaches to develop new payment and delivery models aligned with value to patients.”

Bronson and the ACP urged Congress to scrap the SGR formula entirely to “prevent the nearly 30 percent cut in Medicare payments to services provided by physicians that will occur after the first of the year.”

[See also: SGR remains a contentious issue.]

A triple-step proposition detailing a possible replacement for the SGR formula was outlined in the letter as such:

  • Step 1 -- Enact legislation now to stop the scheduled Medicare cut on January 1 that would also provide direction to the Medicare authorizing committees on a policy framework, process and timetable to report comprehensive legislation to repeal the SGR and transition to value-based payments.
  • Step 2 -- In early 2013 authorizing committees would hold hearings, consult with physician membership groups and other stakeholders, and report legislation, no later than June 30, 2013, consistent with the policy directions required by step 1 and summarized in more detail in ACP’s letter.

  • Step 3: No later than September 30, 2013, Congress enacts comprehensive payment and delivery system reform legislation, based on the bill(s) reported out of the authorizing committees in step 2, to achieve full SGR repeal and to establish a framework of positive incentives for physicians to transition to value-based payment models.

“We urge you to reach agreement on legislation to prevent the across-the-board sequestration cuts in critically important health programs,” Bronson added, “and especially, the nearly 30 percent Medicare payment cut to physicians; establish a pathway and timetable to eliminate the SGR and create positive incentives for physicians to transition to value-based payments; preserve programs to improve Medicaid and Medicare payments for primary care and GME funding to addressing the growing shortage of primary care physicians and in many other specialties, and to achieve savings in healthcare spending by addressing the real drivers of excess cost.”

[See also: SGR uncertainty fuels physician reluctance to enter new Medicare payment and delivery models.]

The ACP was also one of many physician-savvy groups —  the American Medical Association, American Academy of Family Physicians, American College of Surgeons and the American Osteopathic Association were also in attendance — that paid a visit to Capital Hill on Dec. 13 to urge Congress to reconsider the current SGR situation.

[See also: Letter to Congress imparts core elements needed for better Medicare system.]

A cut of nearly 27 percent is slated to affect physicians who care for Medicare patients on the first of the new year if current legislation stands. 

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