Kidneys & Congress

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Candace Stuart, Editor

This week a House subcommittee agreed on a voice vote to advance legislation that eliminates the sustainable growth rate (SGR) formula and replaces it with what lawmakers describe as a stable payment system. Will this be the year of change?

The cyclical shunting of the SGR has symbolized dysfunctional government. Initiated in the 1990s as a way to limit Medicare spending, the federally mandated “doc fix” was repeatedly swept under the rug, creating an ever-widening gap that led to steeper proposed cuts.

The bipartisan legislation offers an alternative that appears to be palatable to the many medical societies that have been watchdogging the bill. The American College of Cardiology (ACC), the Society of Thoracic Surgeons (STS) and the Society for Cardiovascular Angiography and Interventions (SCAI), among others, have been scrutinizing provisions and making recommendations.  

It should come as no surprise that the suggestions further association missions—they encourage the use of registries and appropriate use incentives, for instance. Their work also extends beyond individual causes to physicians as a whole. The ACC is making a case to tie physician payment updates to the Medicare Economic Index rather than a proposed 0.5 percent annual update to be used during a transition to more of a pay-for-performance model.     

Will both parties continue to work together to finally bury the SGR and provide a more equitable and efficient framework?  Keep in mind, the SGR was a swap for previous legislation that wasn’t up to snuff. The House Energy & Commerce Committee and those following its actions have emphasized the need for the legislative process to be transparent. If it indeed is, that should help.

The effort to ensure that the change is more than a Band-Aid may be uniting physician groups. SCAI, for instance, is part of a coalition that together provides support and guidance to Congress on the bill. This kind of partnership may reflect healthcare in the future, with an emphasis on accountable care and the medical home concept.

The medical knowledge base may be heading in that “whole patient” direction as well. This week two studies addressed the kidney-heart connection: one on kidney stones and coronary heart disease and the other on the mortality risk of calcium supplements in patients with chronic kidney disease.

This looks like progress on both the policy and clinical fronts. Would you agree?

Candace Stuart

Cardiovascular Business, editor