Joseph Rugg's Health Law Blog

Physicians added their voices on Wednesday to the intractable task of finding an informed solution to the sustainable growth rate. Sen. Max Baucus (D-MT), chair of the Senate Finance Committee, hosted five physician group representatives, part of a series of roundtables about Medicare payments. Previous roundtables featured former administrators of the Centers for Medicare & Medicaid Services and private payers.

“Every year, the flawed sustainable growth rate, or SGR, leads physicians to fear dramatic reductions in their Medicare payments,” Baucus stated in his opening remarks. “Next year physicians will face a 27% cut if we don’t act. While Congress has intervened to prevent these cuts each year, it is time we develop a permanent solution.

“We need to repeal SGR and end the annual ‘doc fix’ ritual. The year-in and year-out uncertainty is not fair to physicians or the Medicare beneficiaries who need access to their doctors.

“The discussion covered a wide range of topics, including models of care, specialty reimbursements, and quality and efficiency.

Sen. Baucus noted that physicians seem caught in what he described as “stove pipes of care. How do we get rid of some of these pipes?”

Speaking for the American Medical Association, Ardis D. Hoven, MD, said that a variety of new models of care coordination and payment such as medical homes and bundled payments hold promise of a more flexible system and will help. “We have to be accountable as physicians to make sure we are getting the job done and producing outcomes and quality in our work. These new models that are being tested now are going to give us that information, which we have never had before,” she said.

There was general acceptance among the five speakers that while the SGR should be repealed, no single payment replacement system would suffice. Glen Stream, MD, president of the American Academy of Family Physicians, described a blended payment system—common among patient-centered medical homes—that includes a combination of fee-for-service (FFS), care management fee, and quality improvement payments.

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