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Rx for Medicare: SGR fix in balance as Senate debates healthcare reform


With the House and Senate attempting to advance differing visions of healthcare reform, a long-term fix for Medicare's broken sustainable growth rate (SGR) formula hangs in the balance, dermatologists say.

Key Points

But at press time, with the Senate due to take up debate on reform legislation, doctors remained hopeful.

"Healthcare reform hasn't hit an insurmountable roadblock yet," said Scott A.B. Collins, M.D., a Portland, Ore., dermatologist in a private group dermatology practice and a member of the Healthcare Finance Committee of the American Academy of Dermatology (AAD).

Should the bill pass the Senate - hardly a done deal, published accounts say - it would require reconciliation with two House healthcare reform bills passed in November, the Affordable Health Care for America Act (AHCAA/H.R. 3962) and the Medicare Physician Payment Act of 2009 (MPPA/H.R. 3961).

The latter would forestall a 21 percent Medicare fee reduction scheduled for January 2010 and institute a more stable system that would allow the volume of most services to grow at a rate of one percentage point over the gross domestic product (GDP) growth rate (versus GDP without any adjustment today), according to a House Ways and Means Committee statement.

The MPPA also would allow the volume of primary and preventive care services to grow at GDP plus 2 percent annually.

The AAD was among the first medical societies to voice opposition to the PPACA.

Although the academy has provided "constructive comments" on numerous proposed reform components, several PPACA provisions make it clear that "the majority of our input has been dismissed," said David M. Pariser, M.D., AAD president, in a Nov. 20 letter to Sen. Reid's office.

AAD's concerns

Instead of an SGR fix, the PPACA includes a one-year, 0.5 percent payment increase and proposes that a president-appointed independent Medicare commission set physician rates - with no input from physicians and limited Congressional ability to override its decisions, according to an AAD fact sheet.

"Without a stable payment system," Dr. Pariser's letter states, "physicians will be unable to make a long-term investments required to implement health system reform and continue to modernize their practices."

Additionally, the PPACA proposes a 5 percent tax on cosmetic surgical and medical procedures, which would disproportionately affect women and members of the middle class and install the Internal Revenue Service as "an arbiter of what is cosmetic and what is medically necessary," Dr. Pariser's letter states.

The PPACA includes money for primary care bonuses, which the AAD supports, Dr. Pariser tells Dermatology Times. But while House version takes primary care bonuses out of new money, "The Senate bill takes them out of decreased reimbursement for specialists," he says.

Electronic medical record (EMR)-based quality assurance programs contained in both the Senate and House bills could drive older dermatologists into early retirement, he adds.

Dr. Collins added at press time that as a follow-up to the AAD's opposition letter, AAD Association members and staff continued to meet with Senate leadership to discuss concerns about the legislation.

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