Delivery system reforms come second to repealing the Sustainable Growth Rate formula. That’s according to congressional testimony by private sector payers at a recent hearing of the House Ways and Means Committee. While each of the panelists presented compelling ideas for delivery system reform, all agreed that the first step to progress is a new payment model.
“The extent to which Medicare can more more swiftly to payment reforms, I think we’d see progress there,” said panelist Dr. Jack Lewin, the chief executive officer of the American College of Cardiology.
Rep. Mike Thompson (D-Calif.) said SGR repeal, not delivery reform, is the number one concern of both doctors and Medicare beneficiaries.
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“[Doctors] want to make sure that they’re going to get paid for the medical services they provide and Medicare patients want to make sure they’re going to have a doctor to go to; and it stops right about there,” he said. His concerns were echoed by Ranking Member Pete Stark (D-Calif.).
“We keep avoiding the topic of Sustainable Growth Rate formula, in favor of the easier conversations about delivery system reforms, around which we have much stronger agreement,” Rep. Stark said.
Dr. John Bender, president and CEO of Miramont Family Medicine of Fort Collins, Colo., testified that if SGR is not repealed, doctors could have a harder time keeping their practices afloat. He added that he was forced to take out $70,000 loan to cover payroll 4 years ago when SGR was not repealed and Medicare payments were delayed. Today, with stricter policies on loans, that might not be an option, Dr. Bender said, and his practice could go bankrupt.
Len Nichols, director for health policy research and ethics at George Mason University, testified that the Affordable Care Act has brought an end to “business as usual.” He said that Medicare and private payers must work together to find savings, or else face steep cuts.
“We could cut our way to fiscal balance, and in so doing, reduce access to care for millions of Americans. I fear this pathway would likely fail,” Nichols said. “Alternatively, we could align incentives so thoroughly that we actually link the self-interest of clinicians with our common interest in cost reduction and quality improvement, which covering all Americans.”
Rep. Thompson called on his fellow lawmakers to put partisan differences aside to solve the problem that Congress created.
“We have dropped the ball on this one … We need to come together as members of Congress, party stripe not withstanding, and figure out how we come up with the dollars to fix this,” he said.
—Frances Correa (@FMCReporting on Twitter)