A bipartisan plan to repeal the Medicare
Sustainable Growth Rate (SGR) formula is a good start but still needs work, the
Texas Medical Association and eight other states in the Coalition of
State Medical Societies say in a letter to the chairs
and ranking members of the Senate Finance Committee and House Ways and Means
"Another patch, another 'doc fix,' is not acceptable," the coalition added in a follow-up memo to Congress.
TMA physician leaders and physicians from
other coalition-member states spent several days in November meeting
with senators and representatives from both parties, stressing mostly Medicare
The Centers for Medicare & Medicaid Services released its final rule with the 2014 Medicare physician payment schedule on Nov. 27. It also posted a fact sheet on the rule. Unless Congress repeals the SGR or takes some other action by Jan. 1, Medicare payments to physicians will be cut by about 24 percent.
The coalition, which represents 158,500
physicians and medical students in Texas, Arizona, California, Florida,
Louisiana, Oklahoma, New York, North Carolina, and South Carolina, said in the
letter that it supports five components of proposed legislation to "establish
new payment systems that will help physicians keep their doors open to baby
boomers and future Medicare patients":
the flawed Medicare SGR formula.
a fee-for-service program.
current reporting programs and eliminate the current penalties related to the
Physician Quality Reporting System, meaningful use, and the value-based
for complex chronic care management, and
timely performance feedback for physicians.
However, the letter says, "to protect
access to care for millions of Medicare patients and to ensure the
sustainability of America's health care system, these critical improvements
must be made to the current House-Senate proposal":
appropriate annual updates to sustain physician practices.
the costly, clinically irrelevant ICD-10 on permanent hold until ICD-11 or
another usable replacement for ICD-9 is ready for widespread implementation.
the regulatory burden imposed on physician practices.
options, extended timelines, assistance, and financial aid for any small
physician practice that wishes to transition to new payment models, not only
for those in certain locations.
of making incentive payments available only to specific physician practices or
specific geographic areas, allow incentive payments for a variety of
alternative payment models, including ones that DO NOT require physicians to
assume full financial risk.
the cost-effectiveness of all reporting and incentive programs to determine
whether they improve care, reduce total cost, or selectively penalize
physicians who serve specific demographic or cultural groups.
implementing any of the existing VBM measures and methods in a new value-based
payment program, revise them so that:
- The measures and
standards used do not result in financial penalties for physicians when their
patients do not comply with recommendations for testing and treatment;
- Physicians are not
penalized for providing services to disadvantaged patients;
- Physicians are not
penalized for noncompliance with obsolete or superseded guidelines and
- Both cost and
quality measures are adequately risk-adjusted to eliminate the effects of
poverty, poor educational attainment, and cultural differences.
The letter also suggests ways the
government can reduce the administrative and financial burden on physicians in
Medicare. They include creating a "de minimis amount exception for the duty to return overpayments under threat of
the False Claims Act as well as for recovery audits," reversing the requirement that an ordering physician be enrolled in Medicare for the referred physician to be paid for his or her services, and allowing payment for telephone or email
consultations after a face-to-face encounter.
In its follow-up memo, the coalition called on lawmakers to "take immediate
action to work together" to repeal the SGR and not opt for another
temporary fee freeze or small increase as it has done for several years.
coalition's message reminded lawmakers that the "track record for Congress
is not very good. For 12 years, physicians have toiled under the SGR, which
everyone knows is broken. Physician practices have been subject to short-term
patches each year, crippling their ability to plan for the future, even making
them wonder if they'll be solvent for the current year. The decision to further
delay only exacerbates the fiscal albatross around the necks of America's
physicians and the Medicare patients we serve. The vast majority of you say the
SGR needs to be permanently fixed. Let’s do it. Now is the time for action."
Senate Finance Committee has scheduled a Dec. 12 "open executive session" on the draft SGR repeal proposal.
Action, Dec. 4, 2013