Medicalia.org

by Internet Medical Society

Message sent to Medicalia.org by Congressman Jim Gerlach

 

 

Dear members of Medicalia.org:

 

Medicare's current payment formula for reimbursing physicians—the Sustainable Growth Rate (SGR)—is broken.  It must be repealed.  If Congress does not act by the end of the year, physicians caring for seniors will again face an almost 25 percent payment reduction under the SGR formula.  While Congress annually prevents such drastic cuts from occurring with an end-of-the-year "doc fix," now is the time to permanently repeal this fundamentally flawed payment system once and for all.  Seniors and physicians deserve a better system.    

 

As you may recall from our previous correspondence, in August I shared with you the proposal that was advanced through the House Energy and Commerce Committee.  SGR repeal and physician payment reform is also a top priority for the House Ways and Means Committee, of which I am a Member, and Senate Finance Committee.  Working in a bipartisan, bicameral fashion, the House and Senate Committees recently released a joint draft outline to repeal and replace the current system for how Medicare pays physicians.  A copy of this proposal can be found on the House Ways and Means website:  http://waysandmeans.house.gov/uploadedfiles/sgr_discussion_draft.pdf 

 

As part of this process, both the House and Senate Committees invite feedback from the health care provider community and other key stakeholders as they work to develop the best alternative to the current reimbursement formula.  If you have thoughts or suggestions on the SGR proposal, I encourage you to submit them to either or both of the Committees by Tuesday, November 12, 2013.  Written comments can be submitted to the Ways and Means SGR comments mailbox at sgrwhitepaper@mail.house.gov and the Finance SGR comments mailbox at sgrcomments@finance.senate.gov.       

 

Our goal is to repeal the current SGR formula and replace it with a permanent, fiscally-responsible program that improves the quality and value of patient care.  To that end, the draft proposal aims to move from a system of reimbursement that primarily rewards the volume of care provided to one that incentivizes high quality and affordability for our nation's seniors.  The current volume-based system of reimbursement, in some cases, has led to inappropriate and unnecessary utilization of physician services that has driven up Medicare spending.  With the long-term solvency of the Medicare program in jeopardy, the waste, fraud and abuse within the current system must be eliminated to preserve the promise of the Medicare program to today's seniors and future generations.      

 

Lastly, as part of this SGR proposal, the House and Senate Committees support identifying alternative care and payment models, including those being tested in the private sector.  To encourage the use of these new models, the American Taxpayer Relief Act of 2012 included provisions to promote the development and utilization of provider-led clinical date registries and the sharing of timely performance data among physicians.   While the current fee-for-service system will continue to be the standard reimbursement system in the short term, the end goal will be a new payment model for certain physician practices.

 

As Congress works to improve the current SGR system, I hope you will share your views on improving the existing fee-for-service system for physician reimbursement while laying the foundation for a new value-based performance program.

 

With kind regards, I am

Sincerely,

Jim Gerlach
Member of Congress

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