The SGR fix remains a top priority in Congress, with the House still wanting a long-term fix and the Senate unwilling to pay for that. As a result, Thursday of last week Senate Finance Committee chair Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) proposed a bipartisan jobs bill, known as the Hiring Incentives to Restore Employment (HIRE) Act (pdf), in which they would extending current Medicare physician payment rates for seven more months, through Sept. 30, 2010, once again postponing the 21.2 percent cut that was scheduled to take effect on Jan. 1. 

We hear this 7-month reprieve represents a compromise between Senators who wanted a one-year payment fix through Jan. 1, 2011, and others who were seeking an even shorter bridge period to supposedly give Congress time to pass a permanent repeal of the Medicare sustainable growth rate (SGR). 

The HIRE Act is getting trashed as a real jobs creation bill. Majority Leader Harry Reid (D-NV) wants the health aspects out of any Senate jobs bill. HIRE includes extensions of unemployment insurance benefits and COBRA premium assistance for terminated workers, and would extend a number of health care provisions that expired at the end of 2009, including GPCI geographic payments to rural doctors. These provisions are hardly what ‘jobs’ advocacy has been all about, and so this will likely not end up as an SGR vehicle after all.

Along with the AMA, the ACC wants Congress to permanently repeal the formula once and for all.  The short-term, band-aid approaches used in the past to stop imminent cuts only made future cuts steeper and increased the cost of a permanent solution. If Congress had fixed the problem in 2005, when physicians faced cuts of  3.3 percent, the cost would have been $49 billion.  5 years later we face a 21% cut at a cost of $210 billion.

Here’s AMA’s statement of yesterday -- I’d say we’re right with them on this:

”Congress has passed legislation to reinstate statutory pay-as-you-go (PAYGO) rules, which require bills that would increase federal spending to include provisions that offset those costs through spending reductions or revenue increases.  That legislation would also exempt from PAYGO requirements $82 billion of the currently estimated $210 billion cost of a permanent SGR repeal.  The AMA is continuing its advocacy efforts to secure permanent Medicare physician payment reform, and will continue to oppose further short-term fixes.”

Let me translate that -- a much better solution to the HIRE bill idea is to pay it all off at once, with a discount write off of $82 billion, meaning they would have to come up with about $128 billion to get rid of it. They should.

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