Seeking to End the 'Doc Fix'

'Repeal the SGR' Is Leaders' Mantra on Capitol Hill

March 21, 2014 03:41 pm Michael Laff

(Editor's Note: An estimate released March 19 by the Congressional Budget Office now sets the cost of repealing the Medicare sustainable growth rate formula at $180 billion over 10 years.)

Advocates often say that when you want to get legislation passed, you need a unified group carrying a single message. That is the mantra AAFP leaders recently brought to Washington regarding Medicare physician payment.

AAFP President Reid Blackwelder, M.D., left, talks with Rep. Phil Roe, R-Tenn., during a recent visit by AAFP Board members to Capitol Hill.

When members of the AAFP Board of Directors visited Capitol Hill late last month, their main goal was simple: Repeal the longstanding Medicare sustainable growth rate (SGR) formula. "Whenever we met someone in the House, the Senate, or a staff member, we said, 'SGR needs to be repealed,'" said AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn. "That was our message."

A bipartisan bill introduced in February would repeal the SGR and provide a modest increase in Medicare payments until physicians could make the transition to alternative payment models. AAFP leaders and other medical organizations have praised House and Senate members for crafting the bill but noted that the measure did not include details about how to pay for the repeal. And the clock is ticking: The deadline on the current short-term fix to the SGR runs out on March 31.

First Things First

Before heading to Capitol Hill, the Board met with lobbyists from both the Democratic and Republican sides, who explained that the upcoming midterm election cycle and the generally strong partisan tone inside the current Congress make passage of any legislation without offsetting costs to another program extremely difficult.

Story Highlights
  • AAFP leaders are hopeful that lawmakers will pass legislation repealing the Medicare physician payment formula.
  • During a recent visit to Capitol Hill, legislators told AAFP Board members that partisan fighting over spending could jeopardize passage of the bill. 
  • Support for passage of a bill that would repeal the sustainable growth rate payment formula is strong among the medical community overall.

Once on the Hill, AAFP Board members met with several lawmakers, including Reps. Xavier Becerra, D-Calif., and Phil Roe, R-Tenn. Each House member pledged his support for repeal of the SGR. AAFP Board leaders later met privately with House Minority Whip Steny Hoyer, D-Md., and Rep. Michael Burgess, R-Texas. Both Burgess and Roe are physicians who are members of the Republican Doctors' Caucus, and both are sponsors of the legislation.

During their meetings, legislators and AAFP leaders alike acknowledged that another short-term patch to the SGR may need to be implemented -- hopefully, before the March 31 deadline -- because of the continued partisan infighting. "We received a mixed message," said AAFP Board Chair Jeff Cain, M.D., of Denver. "Everyone said they wanted it to happen, but members on both sides of the aisle said it is a tough environment because they haven't come up with a solution for how to pay for it."

The Congressional Budget Office recently estimated the cost to repeal the SGR at $138 billion. According to Cain, that figure is the lowest quoted in recent years, and he likened it to a "fire sale price" that presented a unique opportunity for permanent repeal of the SGR.

The Time Is Now

What is telling is that after 12 years of temporary "doc fixes" that have cost $150 billion, the entire medical community is making an aggressive push to persuade lawmakers to repeal the SGR. This year, the AAFP and a number of other medical organizations put up a strong advocacy campaign( to persuade lawmakers to repeal the flawed formula. The letters, email messages and community outreach that campaign has entailed have raised awareness that years of short-term fixes need to end, and the campaign has resonated among legislators and their staff members.

"This time, we didn't have to explain to anyone what SGR was," Cain said. "The movement was much different than before."

Furthermore, the collaborative campaign to repeal the SGR stands in sharp contrast to the partisanship that has dogged the measure in Congress. "This time, the house of medicine was all on the same page," Blackwelder said. "All the major organizations of significance were able to come to an agreement. It's a unique opportunity."

Still, how to pay for the repeal remains the major sticking point. In some cases, lawmakers were asking leaders in the medical community for suggestions about possible budget cuts in other areas that could help pay for the SGR repeal.

"We're happy to have discussions about that, but we don't have the information that Congress has," Blackwelder observed. "We still want to be engaged."

Overall, despite the partisan atmosphere that predominates in Congress, Blackwelder maintained some optimism that legislation could be passed. "I'm told that three weeks is a lifetime in D.C.," he said. "A lot can happen in a short time."