Experts speak out on SGR patch

The Medicare sustainable growth rate has presented challenges to physicians, hospitals and lawmakers for years. On March 31, in a vote of 64-35, Congress passed the 17thSGR patch since 1997, causing a mix of feelings among physicians, including frustration, relief and hope for the future.

Under the new “doc fix,” titled Protecting Access to Medicare Act of 2014 (H.R. 4302), the 24% cut to physician reimbursements that was due to take effect on April 1 is postponed until March 2015. In its place is a 0.5% payment update in effect through the end of the year, and a 0% update from Jan. 1, 2015, to March 31, 2015.

Unfavorable reactions

Speaking on behalf of the American College of Cardiology’s advocacy steering committee, M. Eugene Sherman, MD, FACC, told Cardiology Today that the ACC is “disappointed” with the process.

M. Eugene Sherman

“In a year where we felt things had come together with a bipartisan, bicameral bill to finally put the SGR to bed and look at more modern payment incentives, and as we switch to value-based purchasing, we were disappointed this didn’t get finalized,” Sherman said.

Some physicians are openly expressing frustration with the process, which L. Samuel Wann, MD, MACC, FESC, said leaves physicians “kind of lost” and too focused on politics.

L. Samuel Wann

“That’s the problem with the SGR. We don’t think we’re getting a fair deal,” Wann, who is a Cardiology Today Editorial Board member and cardiologist at Columbia St. Mary’s in Milwaukee, said in an interview. “We don’t want to be held as a pawn or a ransom by the political system.”

Wann said someone from Congress in his state recently held a talk about repealing the Affordable Care Act, also known as Obamacare.

“I don’t want to take sides, but instead of constructive thoughts about how we can provide better care, and good, quality services, they make it about politics,” he said.

Opposition

Others opposed the SGR patch. The American College of Surgeons issued a letter to top leaders in the House and Senate in March stating it is against the measure. Co-signed by eight additional medical associations, the letter makes the argument that the legislation does not go far enough. “In essence, physicians are paying for their own patch. This action is unacceptable without the full benefit of the SGR Repeal Act. In numerous letters last year, we consistently opposed this flawed provision for its likely disproportionate effect on surgical services.”

In a press release, Molly Cooke, MD, FACP, president of the American College of Physicians (ACP), expressed similar dissatisfaction.

“By voting for the patch, both the House and Senate failed to heed the unified call of physicians, on behalf of their patients, who believe that now is the time for the House and Senate to reach agreement on the bipartisan reforms that were agreed to by the leaders of the Medicare committees of jurisdiction.”

A high price

The American Medical Association also has released a statement in opposition of the SGR patch, in which Ardis Dee Hoven, MD, AMA president, said more taxpayer dollars have been spent on temporary patches than it would cost for a permanent solution.

“The bill perpetuates an environment of uncertainty for physicians, making it harder for them to implement new innovative systems to better coordinate care and improve quality of care for patients,” he said.

Ongoing politics

The patch follows the contentious passage of the SGR Repeal and Medicare Provider Payment Modernization Act (H.R. 4015) on March 14. House Democrats issued a statement on their Energy and Commerce website, stating, “Despite the bill's bipartisan beginnings, the House Republicans added a poison-pill offset that would cause 13 million people to lose insurance coverage and would raise premiums by 10% to 20%.”

House Republicans held a different opinion. When the bill passed, Rep. Renee Ellmers, R-N.C., issued a statement in which she said: "This morning I was proud to vote for legislation that will repeal and replace Medicare's flawed SGR. For the first time since 1997, we have a bicameral, bipartisan solution to the challenges posed by the SGR. For far too long we have passed temporary patches, leaving Medicare patients to fear the loss of their doctors and providers. By passing this bill, we are providing a long-overdue solution for Medicare's payment system, while also replacing it with a system that focuses on quality, value and accountability."

Wann, however, saw the issue a different way.

“I think most of my colleagues join me in my feelings that I’m fed up with both sides,” he said.-- By Shirley Pulawski

Disclosure: Sherman’s financial disclosures can be viewed here. Wann reports no relevant financial disclosures.