When lawmakers agreed to another postponement of the Medicare payment rate, physicians both breathed a sigh of relief and clenched their teeth in frustration. There had been so much optimism that this time Congress would repeal the sustainable growth rate formula. Now doctors are looking at continuing the fight instead of moving on to other issues, like payment reform.
"In the past year, more than 848,000 patients and physicians have contacted members of Congress to tell them it is time to eliminate the broken Medicare physician payment formula and protect patients' access to care," said Peter Carmel, MD, president of the American Medical Association. "The AMA's work on this issue continues, but real relief for patients and taxpayers will only come when Congress gets rid of the problem once and for all."
"… if (Congress) just sort of finger-in-the-dike all of these problems, they're not really taking care of the bigger picture," said Glen Stream, MD, president of the Academy of Family Physicians. "They waste their time because they have to come back and deal with this again. I know doctors are tired of talking to members of Congress about it. And members of Congress and their staff are tired. ... It just needs to be fixed."
Lawmakers chose to postpone the latest physician payment cut of 27.4 percent, which would have gone into effect this week, through the end of this year. When doctors face the rate cut again in 2013, it'll be a cut of more than 30 percent.
[See also: Congress passes doc fix.]
In the interim, doctors and medical societies say they will continue to lobby lawmakers, urging them to repeal the SGR once and for all and to do it far in advance of December.
"Our strategy has always been it's really Congress' responsibility to find out how to fix this," said Stream. "Some of the members of Congress feel like since the debt was related to physician payment that the fix has got to come within the healthcare spend specialty versus another. It's just sort of counter-productive and so our feeling is that they have to come up with the means to fix it."
But not everyone in the industry thinks a repeal of the SGR is realistic, even if it weren't a presidential election season, and that doctors need to come up with a solution on their own instead of waiting for Congress.
"Just look at the numbers," said Matthew Jacobson, CEO and founder of SignatureMD, a provider of concierge medicine. "Numbers don't lie."
With the large numbers of people entering Medicare, he said, there is no way, even with healthcare reform and accountable care organizations, costs will go down enough. The way he sees it, that means lawmakers have three options for cutting costs: cutting the pay rate to doctors, raising the Medicare eligibility age and cutting Medicare benefits.
"Do you think any congress person is either going to raise eligibility age or cut benefits? That'd be political suicide. So what can you do? You can cut rates," he said. "Politicians are hoping that somehow the 2014 reforms are actually going to do something … but anyone who's been doing this knows they won't do anything at all."
"Until people are willing to swallow some really, really sour medicine," he added, "it's not going to get any better."
Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.