This post is written by ACC's Senior Vice President of Advocacy Jim Fasules, M.D., F.A.C.C.

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With ACC’s 2010 Legislative Conference underway, one of the main topics on the agenda is the ongoing battle over the sustainable growth rate (as Jack calls it, the SGRrrr). The SGR is one major part of the formula that is used to determine what rates Medicare pays physicians. Every year for the last 7 years, the SGR has been scheduled to be a “negative update” (meaning that physicians would be paid LESS for the same procedures than paid in the previous year). However, also every year for the last 7 years, the cuts have been overturned at the very last minute. This year, they actually were allowed to briefly take place. Retroactively reversed, the destabilizing force this placed on practices was palpable.  

Delays in addressing the SGR create an unacceptable situation for physicians. With the delays from haggling, we can’t know what our payment rates are going to be in advance, payments can be delayed and we’re put at extreme risk of negative updates in payments at a time when all practices are struggling to survive. Retroactive payment adjustments following claims holds are disruptive to physician practices and contribute to reduced access to care.

In December, the current short-term positive update will expire, leaving physicians facing a 23% cut. Is it likely that Congress will understand the issue and give us a 13-month positive update allowing us to work toward true payment reform? Sure. But more likely it will kick the can only a month or two down the road. Is this what we want ... Is this going to create stability in Medicare payment? No way.

Congress just doesn’t have the courage to fix the SGR, a mess they created. Given that we’re now entering election season, we’re even less likely to get the permanent fix we need. Although we’re unlikely to get a permanent fix, we are working with the AMA and other medical societies on a long-term solution. A 3-5 year SGR temporary patch fix would give us the time we need to test and try payment reforms that improve quality, promote patients, and allow the profession to remain viable for current members and future physicians. The ultimate goal is to repeal the unsustainable formula and install a new and more stable physician payment system. There is little more important than this effort to maintain practice viability.

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