Summer Doldrums for the SGR

The question of what to do about Medicare’s Sustainable Growth Rate formula, which governs physician pay, likely got its final serious look on Capitol Hill on July 11–that is, before Congress heads out the door for a protracted summer recess and then gets caught up in the fall campaign season. And it wasn’t much of a look.

Sen. John Kyl takes notes as physicians talk about SGR. Alicia Ault/IMNG Medical Media

The Senate Finance Committee held its third and final “roundtable” discussion on the SGR, this time allowing physicians to weigh in.  Representatives from the American Medical Association, American Academy of Family Physicians, American College of Surgeons, American College of Cardiology, and American Society of Clinical Oncology politely answered questions from committee members who showed up. Most of the Democrats on the committee sat in,  at least for a portion of the almost two-hour meeting, while only two Republicans attended–John Kyl (Ariz.) and John Thune (S.D.), who came for only the last half hour.

The discussion meandered quite a bit and quite often, with physicians talking about the need for aligning incentives, creating medical homes, and rewarding quality. Dr. W. Douglas Weaver, a past president of the ACC and current Vice President and Systems Medical Director of Heart and Vascular Services, Henry Ford Health System in Detroit, said that the instability caused by the ever-fluctuating SGR situation was thwarting efforts to create new delivery systems.

But there was little concrete discussion of what to do to avert the 27% cut mandated by the SGR that will take effect January 1, 2013.

Senator Max Baucus (D-Mont.), who chairs the Finance Committee and led the

Sen. Max Baucus and Sen. Orrin Hatch listen to physicians. Alicia Ault/IMNG Medical Media

roundtable, at one point said that while he was hearing great ideas, he wanted to know what action could be taken quickly.  Senator Kyl also tried to steer the discussion back to the practical. He also reminded physicians that Congress is driven by 10-year budget-setting imperatives; thus, any suggestions for the SGR proposed for the short term must also work over the long haul, he said.

The elephant in the room: how to pay for an SGR fix or replacement, now clocking in at about $300 billion and rising. Physicians have steered clear of suggesting any financial solutions.

The committee broke with no promises. In an interview afterwards, Dr. Glen Stream, AAFP president, said that any SGR tinkering would likely be put off until at least after the November election. That puts the onus on a lame duck Congress.

Do you think they will make a short term fix or come up with some kind of permanent solution?

—Alicia Ault (@aliciaault on twitter)

Debt Debate Rages On: The Policy & Practice Podcast

Courtesy flickr user SqueakyMarmot (CC)

As Republicans and Democrats battle over a solution to the nation’s debt crisis, doctors’ groups are voicing their desire to see a permanent solution to the Sustainable Growth Rate formula (SGR) as part of that package. Some physicians see the debt ceiling debate as the last chance for quite a while to reach a real solution.

Meanwhile, government official revealed several new Affordable Care Act initiatives including Consumer Oriented and Operated Plans — or CO-OPs — and bundled payments for Medicare.

Also, at the behest of the Health and Human Services department, an expert panel of the Institute of Medicine released its list of recommended preventive health care services for women. Under the ACA, health plans must cover preventive services proscribed by HHS without cost sharing beginning in 2014. The list of recommendations includes birth control, emergency contraception, gestational diabetes screening, HPV testing for women over 30, and STD counseling.

Listen to this week’s podcast for more and share your thoughts.

Check back next week for updates on debt ceiling talks and health reform implementation.

—Frances Correa (@FMCReporting on Twitter)

Image courtesy of flickr user SqueakyMarmot, used under a Creative Commons license.

The AMA’s House Divided: The Policy & Practice Podcast

As the American Medical Association opened its annual House of Delegates meeting in Chicago on Saturday, there was a foreshadowing of the tussle that likely will come over the coming days. The annual policy-making confab always has contentious debate; this year (and as it was last year), the Affordable Care Act stands as more of a dividing than a unifying element for the nation’s physicians.

Michigan Ave., Chicago. Photo by Alicia Ault

The AMA’s president, Dr. Cecil Wilson, told the delegates in his opening speech that while others may pretend to speak for organized medicine, patients and lawmakers look to the AMA as the voice of organized medicine.  Other professional societies can — and have — disagreed.

Other AMA officials highlighted efforts to overturn Medicare’s Sustainable Growth Rate formula and to find cosponsors to support a bill by Rep. Tom Price (R-Ga.), H.R. 1700. The bill proposes to let doctors who don’t accept Medicare still get paid something for seeing patients.

Take a listen to this special edition of the Policy & Practice Podcast.

—Alicia Ault (@aliciaault on Twitter) and Frances Correa (@FMCReporting)

Reform Caught in the Crossfire: The Policy & Practice Podcast

President Obama presented his 2012 budget to Congress last week, but the document received a chilly reception from Republicans and even some Democrats who said it did not go far enough to address rapidly growing entitlement programs like Social Security and Medicare.

The budget did have a sweetener for physicians: a proposal to completely eliminate the dreaded Medicare sustainable growth rate (SGR) formula within 10 years, at a cost of $370 billion.

Via Flickr user the sea the sea

Even as Congress began what is usually a months’ long debate over the next fiscal year’s budget, it was busily waging war over the current year’s funding.  As part of a continuing resolution to keep the government in operation, the House voted in a series of amendments to eliminate funding for Planned Parenthood. It also took huge swipes at dollars set aside to implement the Affordable Care Act.

To hear more about the budget battle and the latest attempt at tort reform on the Hill, take a listen to this week’s podcast:

And come back next week to hear how the Senate addresses the spending cuts delivered to its doorstep while it was on the President’s Day recess.

— Alicia Ault (on Twitter @aliciaault)

SGR Fixed…For Now: The Policy & Practice Podcast

No surprise, but the House followed the Senate and approved a 1-month delay in the 23% physician fee cut called for by Medicare’s Sustainable Growth Rate.  President Obama signed the bill, but everyone’s expecting a repeat of the drill in a few weeks.  Otherwise, the 23% figure climbs to 25% on Jan. 1.

The SGR Show Must Go On. Via Flickr user alancleaver_2000

Short-term delays in those SGR cuts have become a kind of theater that’s getting acted out with increasing frequency. But at least one Republican, Rep. Michael Burgess (Texas), says that it’s more than time for an end to the procrastination on figuring out a better payment method.  Rep. Burgess stands to take over a significant subcommittee in January, and says he expects to start holding hearings on health reform and the SGR within a few days of being sworn in.

Hear what the congressman has to say, along with a report on the president’s deficit commission and the legal challenges to health reform in this week’s podcast.

–Alicia Ault (on Twitter @aliciaault)

Reform Survives First Legal Test: The Policy & Practice Podcast

A federal judge in Detroit gave health reform its first legal victory last week, but the challenge was the first of many the Affordable Care Act will have to weather over the coming months, years, and possibly, decades.

Via Flickr Creative Commons user James Cridland

The White House read the judge’s opinion as backing the Constitutionality of requiring individuals to purchase health insurance.  The litigants — a conservative, self-described Christian law firm — believe the court left a wide gap for appeal.

Meanwhile, physicians are renewing their quest for justice — that is, an overhaul of the Medicare fee formula.  The current pay rate is due to expire Nov. 30.  Last week, the American Medical Association and dozens of other physician groups wrote to congressional leaders pressing for action during the post-election lame duck session.

For more on these issues and a brief interview with a health policy expert with the American College of Surgeons, take a listen to this week’s podcast:

Tell us what you think.

— Alicia Ault (on Twitter @aliciaault)

Medicare Takes on Fraud: The Policy & Practice Podcast

Hey, loyal listeners! Your Policy & Practice Podcast this week features Dr. Don Berwick talking about the beefed up fraud-fighting tools provided by the Affordable Care Act. Instead of reacting to fraudulent efforts, the new tools will help his agency prevent fraud, according to the good doctor.  Listen to his comments here:

Also, in this installment: The election and a looming SGR cut have doctors concerned as well. Do you think Congress will do anything to prevent your Medicare pay from being cut on Dec. 1? Add your thoughts to the comments section.

—Denise Fulton (@denisefulton on Twitter)

SGR Cuts Are Not A Hallucination: The Policy & Practice Podcast

Hard to believe: It’s June 1 and we’re still talking about whether Congress will take action to avoid the 21% Medicare physician fee cut mandated by the Sustainable Growth Rate (or SGR) that was supposed to take effect originally on January 1.

Via Flickr Creative Commons user autiscy

But it’s happened again. The fee cuts go into effect today because the Senate left town without voting on legislation that was approved by the House that would extend the current pay rate by 19 months.

As that oft-quoted philosopher Yogi Berra once quipped, it’s deja vu all over again.

This week’s podcast also discusses another delay that affects physicians, the so-called Red Flags Rule.  And, take a listen to what a Medicare official has to say about how physicians will be scrutinized for fraud and abuse.

Your three-minute rundown is here:

For some other perspectives, see what the Society of Hospital Medicine has to say here about the economics of avoiding the SGR fix, and check out Medical Rants on the “SGR folly” here. And, as always, let us know what you think directly — leave us a comment!

—Alicia Ault (on Twitter @aliciaault)

SGR: The Three Most-Hated Letters in Medicine –The Policy & Practice Podcast

Most physicians would be happy if they never had to read, hear about, or discuss Medicare’s Sustainable Growth Rate, or “SGR” ever again. Alas, it looks like years of attempts to get rid of that formula, which dictates physician fees for Medicare, have come to naught yet again.

Courtesy of Ohio AFL-CIO Labor '08 Flickr Creative Commons stream

Congressional negotiators agreed last week to give physicians a reprieve from the 21% cut due to take effect on June 1, but instead of a replacement for the SGR, they simply said they’d punt on the issue for the next 3 years or so.

Physician groups and even the White House expressed exasperation, yet again, and it was all captured on this week’s installment of the Policy & Practice podcast.

Also included in our 3-minute rundown: a first look at the accountable care organization, or ACO.

Take a listen and let us know what you think:

—Alicia Ault (on Twitter @aliciaault)