The SGR countdown

Twenty-five. That is how many days remain before the patch on the sustainable growth rate (SGR) formula becomes unglued if Congress fails to approve a repeal.

Lawmakers have made progress with the SGR, a reimbursement formula that year after year has been overruled temporarily to avoid cuts in physician payments. The current bite stands at about 24 percent, and if a repeal of the SGR is not passed by the end of this month, the cut goes into effect. A more likely scenario would be a repeat of past stopgap solutions; that is, put off any action until 2015.

Legislators in both houses and both parties agree that the SGR is outdated and needs to be replaced. That is where we’ve seen progress. A month ago they announced that they had reached a deal to repeal the SGR and replace it with annual payment updates of 0.5 percent for five years. But they didn’t include a mechanism for paying for the fix. The Congressional Budget Office recently estimated the cost would add $60 billion to the budget over the next five years.

Public awareness of the SGR debacle rises periodically, but behind the scenes some physicians have been devoting time and effort to keeping the issue at the legislative forefront. An upcoming article in Cardiovascular Business illustrates the role physician advocates play in informing policy makers and lawmakers—as well as their colleagues—of what’s at stake.

They and many others are trying to ensure that not only the “doc fix” happens but that its replacement is a change for the better. The SGR’s original architects didn’t intend for it to punish physicians and potentially impede patient care. Nor do today’s decision makers want to make another misstep.

Whether the SGR gets repealed by the end of the month is an open question. What is not debatable is that physician advocates’ time and expertise have been devoted to making the change, resources that could be directed to other critical needs if Congress could resolve the SGR issue. I imagine everyone would welcome the opportunity.   

Candace Stuart

Cardiovascular Business, editor