Will Farrell, Eminem, and the SGR

This week the 113th Congress will reconvene for a short lame-duck session to complete work on pending matters and organize for the 114th Congress. While the most pressing matter is the need to fund the Federal government, there is one additional item that I believe is deserving of legislative action – the SGR or as it is commonly referred to, the “doc-fix.”

We all know the script. Unless Congress acts by some date in the near future, payments to Medicare participating physicians will be cut by 20-plus percent and access to physician services for seniors, the disabled and military families will be jeopardized. Any additional cuts to physician payments, which are already irresponsibly below actual costs, would force an economic reaction by physicians and physician groups and that reaction would not be positive for our nations Medicare beneficiaries. Very few people argue the validity of these arguments and neither does Congress.

Each year (sometimes more than once per year), for the past 12 years, Congress has intervened to prevent dramatic cuts in Medicare payments, thus preserving access to care for seniors and other beneficiaries. The most recent intervention took place in March. In total, there have been 17 “doc-fixes” at a cumulative cost of $169.5 billion. It is time for Congress to exile this flawed policy from our national health policy conversation once and for all. It is time that we move forward with our eyes cast on what is possible in health care policy unburdened by a failed 1997 policy that has haunted our progress for almost 20 years.

Earlier this year, a bipartisan, bicameral bill was produced and approved by the Finance, Ways & Means and Energy & Commerce Committees. To quote Will Farrell in Old School, “it was glorious.” Every physician organization in the country endorsed the bill and optimism grew that we were close to ridding the Medicare program of this failed policy. While there was a valiant effort made to pass the legislation earlier this year, the conversation around how to pay for the legislation precluded definitive action and Congress passed another short-term bill preventing any cuts until March 31, 2015.

But, why should we wait until March to revisit this issue? There are 4 compelling reasons why Congress should act during the lame-duck:

  1. The annual legislative process of preventing SGR cuts has created an environment that injects uncertainty and far too many politics deep inside health care policy and, quite honestly, rewards bad behavior. It is well understood that the availability of “acceptable pay forms” has become challenging. The process of cutting other industries is politically unpopular and becoming extremely difficult. Making cuts to physician services, pharmaceutical benefits, home health, imaging, labs, and even hospitals to prevent cuts in other areas of the Medicare program also is creating new problems – expensive problems – and aligning interest groups to work against each other and not with each other.
  1. Past approaches to the “doc-fix” have damaged our legislative process and created a massive log-jam in health policy that is threatening the influence of Congress over the direction of our health care system. Let me explain. Congress, through its fiduciary role as the oversight body of the Medicare and Medicaid programs (DOD and VA as well) has, for the past 50 years, had tremendous influence over our health care system – especially in delivery and payment methodologies. Congress was the incubator of thought in health care policy – “was” being the key word. Medicare payment policies fail to support the innovation in care delivery that have been identified over the past decade. One of the primary reasons that programs such as meaningful use PQRS, VBM, and several others are not achieving their desired results is due to the SGR.
  1. The cost is of repeal is underwater. Congress has now spent cumulatively more on short-term fixes than the actual cost of repeal. Earlier this year, in a surprising editorial, the Wall Street Journal suggested that Congress forgo paying for Medicare SGR legislation. A similar suggestion was made by the Washington Post in an editorial regarding the unwavering adherence to CBO projections and how they (CBO) are often wrong. Then, on July 28 the Medicare Trustees did something that few noticed. They acknowledged that it was unlikely that Congress would actually pay for any future SGR repeal. They added four years to the solvency of the Trust Fund at the same time. I recognize that our current budget and political environment makes it very difficult to advance SGR repeal legislation without sufficient financing. However, the Washington Post, the Wall Street Journal, and the Medicare Trustees have all suggested that not paying for all or some of the SGR repeal is acceptable.
  1. The election is over and the next election hasn’t started. Allowing the bipartisan, bicameral legislation to slip into the 114th Congress is fraught with danger. First, there are no guarantees that we can actually draft a bill and secure the level of support the current bill enjoys. Second, it is very difficult to pass health care legislation in a Presidential election cycle. Modern history demonstrates that health care policy is best handled independent of a Presidential race – see BBA, MMA, ACA. Third, I am confident that a large percentage of health care legislative staff will seriously contemplate their career choices if they have to deal with the SGR for much longer.

So, here we are. We have a bipartisan, bicameral bill authored by the Chairmen and Ranking Members of the Committees of jurisdiction that is supported by all of organized medicine. The cost of repeal and reform is at an all-time low and is less than the cumulative cost of Congressional action over the past 12 years. The election is over and there is a growing desire to address this issue in the lame-duck session which was demonstrated in recent letters from the House Doctors Caucus, the Pennsylvania Congressional Delegation, and a letter signed by over 100 Members of the House. The reasons to pass the legislation in the next few weeks far outweigh the reason not to. So, to quote Eminem, “if you had one shot, or one opportunity….would you capture it or just let it slip?”


R. Shawn Martin is vice president of Practice Advancement & Advocacy at American Academy of Family Physicians.

Morning Consult