House repeals SGR, Senate unlikely to follow suit

By a 238 to 181 vote, the House of Representatives approved legislation Friday to repeal Medicare’s sustainable growth rate (SGR).

The SGR Repeal and Medicare Provider Payment Modernization Act would replace the current physician-payment system with one that rewards quality of care and incentivizes doctors to participate in alternative payment models. But, according to news reports, House Republicans attached the SGR bill to a measure that delays for five years the Affordable Care Act’s (ACA) mandate that all individuals obtain health insurance - and because Senate Democrats oppose that delay, the bill is unlikely to win Senate approval. Even if it did, President Barack Obama would almost surely veto the bill, thanks to the anti-ACA measure to which it is attached.

Congress established the SGR 17 years ago as a way to control healthcare spending by linking Medicare payments to the inflation rate. Actual reductions rarely resulted, and since 2003 Congress has enacted annual “patches” - to the tune of $150 billion - in an effort to maintain a sustainable level of reimbursements. Unless the SGR is repealed or yet another temporary patch is put in place by March 31, physicians will see a 24 percent decrease in Medicare reimbursement.

Dermatologists are frustrated by Washington’s failure to fix the problem.

“As medical health-care providers, we have had the repeated angst of the SGR,” says dermatologist Helen M. Torok, M.D., who practices in Medina, Ohio. “Each year we anticipate and hope that Congress will fix the slow leak that they have been patching for the last 10 years. However, the tire is nearly flat - and our indecisive Congress can’t find the compressor to inflate the tire, nor do they have any knowledge of how to inflate it.

“Whether Congress can act in a unified manner remains to be seen,” she adds. “In the meantime, I can hear the slow leak from not one tire but all four, through all the patches that Congress has applied.”

Dr. Torok tells Dermatology Times she thinks allocating payments according to quality metrics is “a very appealing formula,” as it rewards doctors who are efficient and save money for the patient, Medicare and insurance carriers.

Joel Schlessinger, M.D., a dermatologist based in Omaha, Neb., isn’t so sure.

“Tying quality metrics to the payment of a paltry cost-of-living adjustment that bears no resemblance to physicians’ actual out-of-pocket costs for staffing, rent and other expenses is a sham,” he says. “Additionally, quality metrics - whatever that means - is nearly impossible to determine for even one specialty, let alone the multiple specialties that constitute medicine as we know it. Furthermore, it is a convenient way to potentially withhold hard earned-dollars from burned-out physicians.”

Dr. Schlessinger says repeal of the SGR has been a continuing and painful reminder of how completely bankrupt and dysfunctional Congress is.

“Sadly, the newest incarnation of a fix for this ridiculous problem that has plagued the medical profession for the past 17 years is a ‘gotcha’ fix that is more akin to a con-man’s con job than a serious attempt to rectify matters.” 

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