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