Friday, January 8, 2010

The fix is in

I will not sign a health-care bill that “adds one dime to our deficits, either now or in the future, period,” a pledge President Obama has repeated over and over. Unfortunately mass repetition by our very talented Orator-in-Chief can’t solve the biggest obstacle to a deficit-neutral bill: The SGR—not without some political sleight of hand, that is.
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What is the SGR anyway? In short, Federal law requires Medicare payments to physicians to be modified annually using a formula known as the Sustainable Growth Rate (SGR). Because of flaws (what a surprise!) in its methodology, the formula has mandated physician fee cuts almost every year for the past decade.

The SGR formula originally was designed to control Medicare utilization by reducing physician fees. (That’s code for government driven behavior modification.) Then came along PET, MRI, a general shift from inpatient to outpatient care, older, sicker beneficiaries, etc. But the docs are still seen as the bad guys in the cost-containment debate.

So, absent of Congressional action, the SGR will continue to mandate physician fee cuts for the unforeseeable future. Case in point: In July 2008 it took Congress overriding President Bush’s veto of House Resolution 6631, the Medicare Improvements for Patients and Providers Act of 2008 to stop a huge cut of 10.6-percent in fees to docs.

Without a fix to the SGR, doctors’ fees are scheduled to fall by 21.5%, and 40% over the next five years! Of course we can’t let that happen; it would force many doctors to stop seeing Medicare patients. But how do you deliver a budget-neutral bill without cutting fees.

Simple, the D.C. shell game: Rather than include the pricey $247 billion plan known on Capitol Hill as the "doc fix" as part of ObamaCare, the Dems will make this a separate contribution to the deficit, without compensating tax increases or spending cuts.

Doctors just want fair pay for their valuable services. Policy makers in D.C. need to get their collective heads out of the sand and address this issue before we can see real reform to our system.

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