Nephrologists won’t be welcoming a new year in January if Congress can’t finalize a plan to update how Medicare pays for physician services.

The Senate Finance Committee has scheduled a meeting for Dec. 12 to discuss repealing and replacing the Medicare sustainable growth rate formula with a quality incentive-based plan. If the changes can’t be passed by January 1, physicians may face a 24.4% cut in Medicare pay.

(CMS retains 12% cut in drug payments for ESRD care, approves new QIP measures)

Democratic and Republican House and Senate leaders had released a draft proposal of legislation that has been supported by the American Medical Association but includes a 10-year payment freeze.

The legislation “would end the SGR's annual cycle of uncertainty and protect seniors' access to their doctors,” Senate committee's leaders Max Baucus, D-Mont., and Sen. Orrin Hatch, R-Utah, said in a media advisory. “It would also help shift Medicare away from the inefficient fee-for-service payment model by rewarding the value of care over volume.”

(Where Medicare and the ESRD Program are headed)

The Office of Management and Budget has projected the cost of replacing the SGR at $138 billion, a significant decrease from a previous estimate of $297 billion because of slower projected growth in Medicare spending. The proposal, however, doesn't mention a means to cover that cost, and Baucus and Hatch said they would “address offsets for the legislation separately.” Physician payments represent about 16% of Medicare spending.

The AMA has supported Congressional efforts to end the SGR, but AMA president Ardis Dee Hoven, MD, acknowledged in a speech to AMA delegates last week that the proposal is “a mixed bag…I'm not going to sugarcoat it—there are things I really don't like about the proposal; chief among them, the idea of a 10-year payment freeze,” she said. Hoven said the freeze is unwarranted because Medicare payments are currently 20% below the cost of delivering care. “It makes you want to throw up your hands and scream,” Hoven said, but added, “walking away right now would be a colossal mistake.”