Efforts to find a long-term fix for Medicare’s Sustainable Growth Rate (SGR) formula for physician payment will have to wait until 2015, the co-chairman of the Republican-formed GOP Doctors Caucus said Dec. 4.
Speaking to reporters, Rep. Phil Roe (R-Tenn.) said he plans to take up the issue in the early days of the 114th Congress. For now, though, SGR reform is “DOA. It’s not going to happen this year,” Roe said.
Congressional leadership has been under pressure from outside stakeholder groups as well as lawmakers to pass a permanent SGR fix. The American Medical Association, the GOP Doctors Caucus, and a coalition of primary care doctors that includes the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have all pushed for an agreement to be reached this year instead of waiting until the current patch expires March 31, especially since the price to do so keeps rising.
Without any action, Medicare payments to doctors would be reduced by 21 percent, although Congress has passed temporary patches every year to avoid similar cuts.
The Congressional Budget Office Nov. 17 said bipartisan, bicameral legislation (H.R. 4015, S. 2000) to replace the SGR would cost $144 billion from fiscal years 2015 to 2024, a jump from the $138 billion, 10-year estimate that the CBO made in February when the identical bills were introduced.
H.R. 4015 passed the House in March but not the Senate, when lawmakers couldn’t agree on how to pay for it. The most recent short-term Medicare doc pay patch was signed into law April 1.
Roe said he was in favor of the policies contained in H.R. 4015 and didn’t feel like they would need to be negotiated anew next year, especially because they were bipartisan.
“I’m not saying there wouldn’t be a tweak or something, but I’m satisfied with the policy,” Roe said. “Once you’ve got a grand slam home run like that one was—an agreement on policy—I don’t think you’ll revisit that.”
How to Pay for It?
Roe said the pay-fors remain the biggest stumbling block to getting a deal done. The House Ways and Means Committee “will have to come up with a plan. They couldn’t get that done this Congress,” Roe said.
Roe said he would insist on offsetting the costs of a full SGR repeal but also said he was open to only partially offsetting it. Roe wouldn’t specify if any other lawmakers shared his view about partial offsets but said he wasn’t “a lone wolf.”
Roe acknowledged also there’s a chance the negotiations will get caught up in acrimonious politics of the Affordable Care Act but said he hopes that isn’t the case.
Roe said the last SGR bill “was done in a real bipartisan way. I think both sides of the aisle understand that it needs to get done. We need to replace it with a sustainable system that hopefully will lower costs for people.”
Takeaway: Congress is unlikely to find a long-term fix for the SGR any time soon, but a short-term fix is likely before physician payments are cut by 21 percent.
