What Does the SGR Fix Really Mean to Doctors?

Gregory A. Hood, MD


March 23, 2015

In This Article

After More Than a Decade, a "Doc Fix": 5 Key Points

In a refrain that is familiar but long awaited by those of us who regularly visit Capitol Hill and meetings with members of Congress, there is yet again a bicameral, bipartisan SGR fix before lawmakers.

I think this proposed SGR fix is necessary for survival, and hence good. It does not make life substantially better but it makes it possible.

House Speaker John Boehner and Minority Leader Nancy Pelosi have put forth a deal that would result in a vote on a full SGR repeal. It would also reauthorize the Children's Health Insurance Program (CHIP) before the latest (of 17) SGR "patches" expire on April 1. The Congressional offices I've spoken with expect there to be a vote by Thursday. What chance does this have and what do you need to know about this proposed legislation?

Point 1. This (Still) Matters

"It's not a doc fix. It's a fix for America's seniors so that they can continue to see their doctors under Medicare." –Pelosi[1]

"It's a chance to get rid of Washington's most infamous budget gimmick." –Boehner[1]

In this era of novel payment models, accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and other acronyms and initiatives, some have pondered whether the SGR is really still significant.

It is. The cut which will come into effect on April Fool's Day is no joke to practices as they struggle to survive. A 21% reduction in Medicare payments cannot be brought to book against the rising costs of providing health insurance to employees, sustainable employee salaries in the face of the perpetual loss of consumer purchasing power, incessant health information technology expenses, and other economic realities which medical entities must successfully manage today in order for US healthcare delivery to have a tomorrow.

After more than a decade of repeated trips into every willing Congress member's office to deliver the same message (a lone member of my state's delegation repeatedly has refused to meet with me about this), the "fix" before them is much the same as what has been proposed last time, in 2014. In spite of the issue not seeming to change in the eyes of Congress, much has changed in the healthcare landscape as a result of this ongoing blight in the past dozen years.

The financial uncertainty and related consequences of inaction by Congressional sessions that have at times been led by either party has had an inhibitory effect on the sorely needed growth, recruitment, and innovation in primary care.


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