Tuesday, March 24, 2015

What Does the SGR Fix Really Mean to Doctors?

After More Than a Decade, a "Doc Fix": 5 Key Points

National Physicians Call-In Day on Tuesday, March 24. Please help spread the word to your colleagues - we want as many physicians as possible to be flooding the phone lines of their U.S. representatives to make the case for SGR repeal now! Make sure you call on Tuesday: (800) 833-6354.

After 17 years of kicking the can down the road it seems the SGR  will blow away in a  cloud of dust, leaving what ?

In this era of novel payment models, accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and other acronyms and initiatives, some have pondered whether the SGR is really still significant.  It is true, the landscape of  reimbursement and health financing barely resembles that of 1997 when the SGR (Sustainable Growth Rate) adjustment was designed to  counteract the increase in the senior demographic becoming eligible for Medicare.  

Medicare payments barely resemble those of 1994 when draconian cuts were made to fees to physicians unrelated to an SGR.  Cuts of 2 to 5 % had been expected each year, and now 15 years later the SGR lies fallow like an abandoned ICBM rusting in the South Dakota plains.

Chronic diseases have become a major category of spending, new treatment models, payments dependent  upon outcomes, quality of care, and a decreased emphasis on a strict fee for service. The new buzz acronym is P4P (Pay for performance).

The conversion to payments for quality of outcomes is not  a total abandonment of fee for service. Not at all !.  It is not a  pre-paid formula, or a payment model designed like a DRG (Diagnosis related group) where payments are tied to the disease being treated.

What is occuring is the use of fee for service with a bonus incentive/penalty for non compliance. This will be administered with a thick overlay of algorithms following a mystery calculus of big data forthcoming from meaningful use standards built into the federal HIT system.  The system of EHRs and the HIEs still yet to be built are the bedrock of this new as yet implemented feature of the ACA.  Never you mind the additonal acronym of  ACO (Accountable Care Organization).

Yes, our nation is one of  'Exceptionalism" (except for this, or for that).

So the SGR was not important.....it never was, just to use as a negotiating point and used as a bishop at the last minute in the war on physicians, who invested untold millions of dollars via the AMA and other physician group lobbying on the hill the past 15 or more years.

The final shovel of dirt will fall on the SGR casket with the change to ICD-10 making all previous ICD 9 codes obsolete and fossilized.

The SGR never had a chance to become a fossil, rather it never lived and it's DNA became extinct before it was born.  Conceived, yes, then miscarried before it's birth.

National Physicians Call-In Day on Tuesday, March 24. Please help spread the word to your colleagues - we want as many physicians as possible to be flooding the phone lines of their U.S. representatives to make the case for SGR repeal now! Make sure you call on Tuesday: (800) 833-6354.

House Speaker John Boehner and Minority Leader Nancy Pelosi have put forth a deal that would result in a vote on a full SGR repeal. It would also reauthorize the Children's Health Insurance Program (CHIP) before the latest (of 17) SGR "patches" expire on April 1. The Congressional offices I've spoken with expect there to be a vote by Thursday. What chance does this have and what do you need to know about this proposed legislation?



Point 1. This (Still) Matters

"It's not a doc fix. It's a fix for America's seniors so that they can continue to see their doctors under Medicare." –Pelosi[1]

Point 2. Approval Is Not a Sure Thing

This "fix" is essentially no different from the bipartisan, bicameral (House and Senate) SGR Repeal and Medicare Provider Payment Modernization Act of 2014

Point 3. Organized Medicine Is United in This Effort

Last Monday, a letter[2] endorsed by over 750 physician membership organizations was delivered, urging Congress to pass legislation, based on last year's bill, before the SGR patch expires on April Fool's Day.

Point 4. The Bill Does More Than Just Fix the SGR (And Should Do Still More)

Throughout lobbying efforts restoring Medicaid Primary Care Pay Parity has been a linked objective. Additionally, the Medicare Primary Care Incentive Program, which has provided internists and other primary care physicians 10% bonus payments on their office visits and other designated services since 2011, is set to expire at the end of 2015.

Point 5. The Time to Act Is Now

Medicine is not receiving everything it has asked for. Medicine is not receiving undue gifts or treatment. Primary care, which takes care of vast numbers of Medicare recipients in this country, remains dramatically undervalued to the great detriment of public health and national economic productivity, and is still inhibited from delivering the moral breadth and depth of services smoothly and thoroughly across the nation's towns and neighborhoods for which those of us in the profession chose this life.
It is essential that every physician and every patient who receives, or hopes to receive, primary care call their representatives, and especially their Senators, NOW to encourage an affirmative vote prior to the April recess.
National Physicians Call-In Day on Tuesday, March 24. Please help spread the word to your colleagues - we want as many physicians as possible to be flooding the phone lines of their U.S. representatives to make the case for SGR repeal now! Make sure you call on Tuesday: (800) 833-6354.

Attribution :  Medscape





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