Get past the politics and repeal the SGR formula

Last month, when federal lawmakers--on a bipartisan basis--reached a deal to permanently repeal the sustainable growth rate (SGR) formula, it seemed that it's end finally was at hand.

But now, a month later, politics has reared its ugly head and threatens to derail that agreement. According to recent reports (like this one from NPR), the SGR fix is now in trouble over the issue of how to fund the $138 billion cost of the repeal over the next 10 years.

The bill, passed by the House of Representatives, contains a provision to offset that $138 billion--but it's a provision that includes language inserted by Republicans that delays implementation of the penalties for the individual mandate provisions of the Affordable Care Act. Even if this gets through the Senate (which is unlikely), it's certain to be vetoed by President Obama.

"This bill will pass today and go nowhere," Rep. Frank Pallone (D-N.J.), a senior member of the House Energy and Commerce Committee, said during the bill's vote Friday. "It will not be taken up by the Senate. It will not be signed by the President. You have single-handedly, in my belief, stomped on months and months of hard work and effort by my colleagues on both sides of the aisle and our staffs."

Medical organizations, including the American College of Radiology, also are disappointed, to say the least, over the latest turn of events.

"I am writing to profess our profound disappointment that a strong bipartisan, bicameral effort to repeal the Medicare sustainable growth rate has become a victim of partisan approaches," American Medical Association CEO James Madara said in a letter to House Speaker John Boehner and House Democratic leader Nancy Pelosi. "We renew our call for all parties to engage in good faith, bipartisan efforts to address the budgetary implications of this bill and enact it. We stand ready to work with you in this endeavor."

All of this "political posturing" means that Congress will be forced to enact yet another SGR patch to prevent the 24 percent payment cut to physicians, scheduled to go into effect April 1 due to the SGR formula. Radiologists could be at risk if Congress has to resort to a short-term fix on a pay-for basis. For example, such a fix could include a pay-for provision creating a mandatory radiology preauthorization program for Medicare contracted to radiology benefit management companies.

A permanent SGR repeal has broad political support, but as I said previously, it will have to be paid for. Both Republicans and Democrats must work together to identify and pass these offsets in a bipartisan manner--as difficult as that may be in an election year. - Mike (@FierceHealthIT)

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