Congress Takes Up Medicine's Plea on SGR, IPAB

TMA officials are optimistic about proposals to reform Medicare's physician payment system this year, a top goal for the association's federal legislative agenda.

TMA physicians met with congressional leaders as part of the American Medical Association's National Advocacy Conference in February to advocate for an alternative to Medicare's Sustainable Growth Rate (SGR) formula, which doctors say does not keep up with the cost of care and deters them from caring for senior patients.

Republican leadership of the House Ways and Means Committee and the Energy and Commerce Committee jointly unveiled plans for a three-phase bill that would eliminate the SGR and move toward a system that pays doctors based on physician-endorsed quality measures, and later on efficiency.

Also in February, Rep. Allyson Schwartz (D-Pa.) and Rep. Joe Heck, DO (R-Nev.), reintroduced the Medicare Physician Payment Innovation Act (HR 574) to repeal the SGR formula and test new payment models that promote quality and reduce costs.

Both plans reflect core principles that medicine, including TMA, advocated to Congress for transitioning from the SGR to a new, high-performing Medicare system.

House Energy and Commerce Committee Chair Rep. Fred Upton (R-Mich.) said he hopes to have a bill on the floor this summer. His committee held its first hearing on the SGR in February, which TMA officials say is a good sign of long-overdue progress on the issue.

The plan also has support from a key lawmaker in Texas, U.S. Rep. Kevin Brady (R-The Woodlands), Health Subcommittee chair of the House Ways and Means Committee.     

The SGR proposals came not long after the Congressional Budget Office (CBO) revised its estimate for the 10-year cost to repeal the SGR formula down from $243 billion in 2012 to $138 billion in 2013. Representative Upton suggested the lower cost could make it easier to pass legislation on the issue this year.

Texas physicians also pressed lawmakers for repeal of the Independent Payment Advisory Board (IPAB) set up under the Patient Protection and Affordable Care Act (PPACA), another key goal on TMA's agenda.

Doctors say the board's ability to arbitrarily cut Medicare costs – which, because of restrictions on limiting benefits, are likely to hit physician payments – could be a double blow to access to care for Medicare patients on top of existing payment cuts. Physicians also worry the 15-member panel of health care experts takes decisions out of the hands of doctors and patients.

Medicine supports legislation introduced in the Senate and House to repeal the IPAB: S 351 by Sen. John Cornyn (R-Texas) and HR 351 by Rep. Phil Roe (R-Tenn.).

"The PPACA prohibits the [IPAB] from recommending changes to Medicare eligibility or coverage, or other factors that drive utilization of health care services. This means the board will have only one option – cut payments," TMA President Michael E. Speer, MD, said in a letter thanking Senator Cornyn for introducing the legislation. "And through 2019, hospitals, Medicare Advantage plans, Medicare prescription drug plans, and health care professionals other than physicians are exempt. That leaves the board only one option – cut Medicare payments to physicians. Cuts the board recommends will take effect automatically unless Congress acts to suspend them.”

Similar measures passed the House in 2012, but did not get through the Senate. 

Action, March 1, 2013

Last Updated On

July 19, 2013

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