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.
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.”
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.”