AAFP Leads Call for SGR Fix on Capitol Hill

The AAFP recently urged congressional leaders to stop a scheduled 10 percent reduction in Medicare payment rates next year and to provide positive payment updates in 2008 and 2009. That request was made during a series of July 10 meetings on Capitol Hill and reiterated in a press briefing just after the visits.

"We sat down with the leadership of both the House and the Senate, Republican and Democrat, and asked them to work together to try and find a solution to this," said AAFP President Rick Kellerman, M.D., of Wichita, Kan., at a press briefing shortly after the congressional meetings. "This is not a new problem. We have been dealing with this problem for at least six years."

The sustainable growth rate, or SGR, formula determines Medicare physician payment rates. During the past several years, use of the SGR formula has led to deep reductions in physician payment levels, reductions averted only by last-minute congressional intervention. Without congressional action, the SGR formula will dictate a 9.9 percent reduction in Medicare physician payment rates in 2008, followed by a 5 percent cut in 2009.

"Everyone agrees this formula does not work," Kellerman told members of the press. "Congress agrees this does not work. We have been trying to help Congress find a way to change the way these physician fees are set."

Kellerman attended the Capitol Hill briefings with John Crosby, J.D., executive director of the American Osteopathic Association, and John Tooker, M.D., EVP and CEO of the American College of Physicians. Collectively, these organizations, along with the AAFP, represent nearly 300,000 physicians, most of whom work in the primary care field.

Specifically, Kellerman and the others met with Senate Majority Leader Harry Reid, D-Nev., and Senate Minority Leader Mitch McConnell, R-Ky. On the House side, the three met with the legislative health aide to House Speaker Nancy Pelosi, D-Calif.

"The Medicare physician payment system is 'sicko,'" said Crosby during the press briefing, making a pointed reference to a recently released documentary film on the U.S. health care system made by Michael Moore.

At the briefing, Kellerman, Crosby and Tooker noted that the House Energy and Commerce Committee and the House Ways and Means Committee are working jointly on an SGR fix as part of a bill that would reauthorize the State Children's Health Insurance Program, or SCHIP. Under the House legislation, physicians would receive a 0.5 percent increase in Medicare physician payment rates in both 2008 and 2009.

"It is absolutely critical that Congress provide stable, predictable and positive Medicare updates in 2008 and 2009," said Tooker at the briefing.

During their meetings with the AAFP and the other organizations, congressional leaders expressed concerns about how to pay for an SGR fix. Although an increase in the federal tobacco tax as a way to offset the costs was discussed during the meetings, "We proposed the patient-centered medical home as a long-term strategy to provide savings in the system," said Kellerman at the briefing.

The House SCHIP reauthorization bill is not expected to specifically address a patient-centered medical home. But the medical home "came up in every conversation we had on Capitol Hill today," said Crosby. If Congress provides an SGR fix for the next two years, physician groups will have a greater opportunity to "utilize concepts and issues like the patient-centered medical home," he added.