Big Push on the Super-Committee for a Permanent “Doc Fix”
Our industry needs to be watching the workings of the Congressional deficit Super-Committee for obvious reasons: Medicare is one of its biggest targets for reining in Federal spending. Hands-down the biggest issue facing Medicare Advantage is an indirect one: whether the “Supers” will address the Sustainable Growth Rate (SGR) methodology that determines reimbursement for physicians under traditional Medicare. Docs are facing a 29.5% cut to their payments in January 2012 unless the Congress intervenes. If they don’t and the cut takes place, Medicare Advantage rates will fall by more than 7% in 2013, and that would be a disaster. Various interest groups and some influential Members of Congress are beginning to weigh in.
Rep. Allyson Schwartz (D-PA), the second highest ranking Democrat on the Budget Committee and a leader on healthcare issues, issued a “Dear Colleague” letter Wednesday morning asking her colleagues to demand a permanent fix to the SGR. Since 1997 the Congress has kicked this can down the road several times through short-term fixes, but doctors want a permanent fix to the payment formula. And so do MA plans.
But fixing the SGR comes with a daunting $300 billion price tag, which killed efforts to address it in the ACA. Leaving the law on the books, Schwartz wrote, would double the price tag to almost $600 billion over the next five years or force the Medicare program to slash payments to a level that would force thousands of physicians to leave the program.
Physician groups across the country are also demanding that the Super-Committee tackle the problem. Last week, dozens of state and national medical organizations signed on to a letter drafted by the American Medical Association demanding action.
“With a 30 percent across-the-board payment cut in physician services scheduled for January 1, 2012, the implications of continuing this practice of simply putting off cuts to future years are clear. Continued access to care for our nation’s senior and disabled citizens is seriously threatened,” the doctors’ letter reads. “The fiscally responsible course is clear. This is the time to repeal the SGR so that new payment models can be adopted that promote high quality, cost effective care.”
AHIP and other health plan trade organizations have been eerily quiet about the SGR — and that’s unconscionable given how much damage another punt on the doc fix could do to Medicare Advantage, not just in terms of payment cuts in 2013 and beyond, but also for what it would mean to beneficiary access to physicians. MA plan provider networks would look like swiss cheese with docs by the thousands refusing to accept Medicare assignment. It’s time our industry weighed in and helped ensure the SGR goes the way of the dodo in the continuing budget debate — doing a solid for our partners in the physician community while saving our own hides.