The SGR Groundhog Day Moment
Friday, December 16, 2011
Once again, physicians find their holiday season dimmed by a congressional gridlock concerning the annual doc fix. As the year counts down to December 31, many are asking the same question: what will it take?
Last year the battle to fund the Medicare deficit — $19 billion for the fiscal year — ended in a one-year measure. The summer saw a hands-off stance from the Center for Medicare and Medicaid Services when the administration instructed providers to temporarily cease filing claims until Congress resolved a standstill over stimulus spending and unemployment benefits.
The cut projected for January 2012 should Congress fail to enact the customary doc-fix totals to 27.4%.
The core conflict for legislators — 19 of whom are physicians, themselves — emerges in the inability of the Sustainable Growth Rate (SGR) to adapt in today’s economic environment. The formula was originally developed to bind spending to the economy’s growth. Despite initial success, the exponential climb in health care costs out quickly surpassed the overall market. The subsequent deficits to fund Medicare were further compounded by the recent depression and ongoing recession.
Even if Congress is able to act in time with a temporary doc-fix over the holidays, the fundamental dilemma will remain a question of funding just as the patient population eligible for Medicare benefits enters a major boom.
“Each year more has been on the line,” states American Medical Association (AMA) President Peter W. Carmel, M.D., in a recent blog post that casts the impending influx into the historical context. “The scheduled cuts have increased from 5% in 2002 to the current cut of 27% slated fro January 1. The number of older Americans whose access to care is threatened by these cuts continues to rapidly multiply, as 79 million baby boomers have begun joining the ranks of Medicare patients,” writes Dr. Carmel. “The cost to repeal the SGR has risen from $48 billion in 2005 to $300 billion today. And that figure keeps growing.”
Dr. Carmel is hardly the first AMA leader to call attention to the downward spiral. It was past AMA President J. James Rohack, M.D., who likened the annual doc-fix deadline to the movie Groundhog Day and Dr. Carmel’s immediate predecessor, Cecil B. Wilson, M.D., characterized the gridlock as a “never-ending race.”
This year, the AMA president is not only writing about the SGR situation, but also offering an avenue for physicians to propose their own solutions — a perhaps move the debate closer to resolution — through grassroots physician advocacy. According to Dr. Carmel, the organization directed more than 250,000 email and phone calls to Congress during the fall.
For more information about the AMA’s grassroots advocacy, visit www.ama-assn.org.
November 30, CMS issued a new directive that will allow nearly 15 million obese Medicare patients to see their primary care doctor for "free" up to 20 times in one year for face to face obesity counseling.
That's potentially 300 million doctor visits which is 100 million more office visits then Medicare patients see their primary doctor now for all reasons. (There are nearly 50 million Medicare patients who see their primary care doctor an average four times a year). CMS set the reimbursement fee at $34 for each visit.
Do the math and this new benefit could potentially cost $10 billion.
Before CMS issued this ruling, they did no actual cost benefit analysis; no estimate of the total cost of the program or whether this new service can even be delivered. (Isn’t there a well known projected shortage of primary care doctors?)
The Affordable Care Act gave CMS the power to do this which rivals anything Soviet era central planning ever tried to accomplish.
How is this new CMS benefit is any different than when the Central Committee set wheat production goals by fiat and then set the price of bread without any concern if the wheat could be grown or the price of bread could cover the cost of production?
The Affordable Care Act is an oxymoron, if there ever was one. Remember when Pelosi said the bill would have to pass before we could find out what was in it? Surprise!
Meanwhile, as it stands now, physicians are going to take a 27.4% cut in Medicare reimbursements on January 1st. Where's Alice? I think I'm in a rabbit hole.
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Medicare-to-reimburse-for-obesity-screening-and-co/ArticleStandard/Article/detail/752457?contextCategoryId=40158&ref=25