March 26, 2015

SGR is on Congress’ Agenda This week: What is It? A Primer for Diabetes Advocacy

SGR is in health news. MedPage Today ran a piece March 25 by Joyce Frieden titled, "Bill to Kill SGR Likely to Pass House, but Fate in Senate Less Certain." Her opening sentence is:

WASHINGTON -- Negotiators are working feverishly and President Obama has a pen at the ready, but whether a permanent repeal of the widely disliked "sustainable growth rate" (SGR) formula for Medicare reimbursement can happen this week is still up in the air.
Wait. The house and the President are interested in the same thing passing. In health. What the... is SGR.

SGR is a process Congress created in 1997, to restrain the cost Medicare pays doctors. The idea is that growth in Medicare cost should be linked to the growth rate in the US economy. SRG triggers cuts in physician payments if doctor costs exceed targets. It is very formula heavy. Congress has to March 31 to step in before there are cuts to doctors for seeing Medicare patients. Those cuts would be over 20%. The fear is then that doctors would stop seeing Medicare patients.

For the last decade, Congress has prevented these cuts with short term fixes. The Brookings Institute says, “However, since 2002, Congress has stepped in with short-term legislation (often referred to as the “doc fix”) to avert the payment reduction. These patches have kept increases in physician payments below inflation over time.” There are voices calling for a longer term process as well as those less concerned with regular consideration congressional action.

There are concerns over the SGR patch process as well. For example, since payments are on a fee for service basis they encourage volume of services billable Medicare over quantity of care. The process does not consider doctors or practices based on performance. Cuts may limit seniors access to care.

Because Congress has consistently passed SGR patches, the legislation often attracts other issues as riders. CHIP programs for children and  funding for the Special Diabetes Program are advocacy priorities of the American Diabetes Association and JDRF.

Here are some resources to learn more about SGR:

The Brooking Institute:
A primer on Medicare physician payment reform and the SGR

MedPage Today
Bill to Kill SGR Likely to Pass House, but Fate in Senate Less Certain

Internal Medicin News
FAQ: What’s in the House proposal to fix the SGR?

American Diabetes Asscocation Call to Action

JDRF Call to Action

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