Will SGR repeal pull doctors away from sickest patients?

The pending Medicare Access and CHIP Reauthorization Act has the potential to harm patients, according to a right-of-center think tank.

That bill, which was recently passed in the U.S. House of Representatives with wide bipartisan support, is awaiting a vote by the Senate. In addition to reauthorizing the Children's Health Insurance Program, it would also repeal the Sustainable Growth Rate (SGR) payment formula for physicians participating in the Medicare program. 

President Barack Obama recently announced that he intends to sign the bill if it reaches his desk.

The National Center for Public Policy Research (NCPPR) believes a component of the bill, the Merit-Based Incentive Program (MIP), which provides quality incentive payments to physicians, would actually encourage doctors to avoid some patients.

"Consider A1c, the level of a patient's blood sugar and a common quality measure for diabetics," said David Hogberg, a NCPPR senior fellow, in a statement. "Physicians who are subject to this quality measure can boost their score by limiting their diabetic patients to those who are easy to treat. They will avoid diabetic patients who need much more encouragement and monitoring, since taking on too many of those patients could result in a below average score on the A1c measure and, hence, a penalty."

Although the NCPPR did not provide any specific evidence that doctors would act in such a manner, a new policy analysis issued by the organization concluded that "it can be expected that MIPS scoring will encourage physicians to 'game the system' by eschewing sicker patients." The report used an employee evaluation process known as "stack ranking"--wherein employees are graded on a curve--as a means of comparison.

Hogberg cautioned that "it would be wise for the Senate to slow down the process and eliminate MIPS from the legislation."

To learn more:
- read the NCPPR statement 
- check out the NCPPR report