For Physicians, The Question the White House Won’t Answer
Several press stories this morning have highlighted an article that Administration advisers Nancy-Ann DeParle and Zeke Emanuel wrote for the Annals of Internal Medicine regarding the supposed benefits of health “reform” to physicians. The key paragraph discusses the current status of the sustainable growth rate (SGR) mechanism for physician reimbursement under Medicare, and is most noteworthy for what it DOESN’T say:
Finally, we acknowledge that many physicians are disappointed that Congress has not yet enacted a long-term fix to the sustainable growth rate formula. No one is more disappointed than President Obama, who made clear: “For years, I have said that a system where doctors are left to wonder if they’ll get fairly reimbursed makes absolutely no sense. And I am committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors.” The uncertainty surrounding the sustainable growth rate policy is a distraction and potentially a barrier for some physicians to embrace the Affordable Care Act. But physicians should not let their frustration over the sustainable growth rate distract them from the improvements that health care reform delivers to their patients and the profession.
The $371 billion question that went unanswered in that paragraph is this: Does the Administration support paying for long-term SGR reform, and if so, how does the White House propose to offset this new spending? There have been several conflicting signals from the Administration on this count – the President’s budget proposed $371 billion in new spending to “fix” the SGR without offsets, while Secretary Sebelius recently claimed that any changes to the SGR formula would be “fully paid [sic].” The President’s gauzy talk of “balanc[ing] fiscal responsibility with the responsibility we have to doctors” is cheap if the Administration does not lay out a specific plan to pay for the staggering sums necessary to resolve the SGR problem.
While the article attempts to focus physicians’ attention on other delivery system provisions in the law, few physicians facing a 23 percent cut in Medicare reimbursements come December 1 – followed by a further 6.5 percent cut the following month – will be focused on anything but the SGR cuts’ dramatic impact on their practices. Just this month, the Medicare actuary called the entire SGR mechanism “unsustainable,” because of the impact the looming reimbursement reductions would have on beneficiary access.
Democrats exacerbated our entitlement crisis by using more than $500 billion in Medicare savings not to maintain Medicare beneficiaries’ access to physician care through a long-term SGR fix, but instead to create new entitlements for other Americans. The least this Administration could do is put forward a credible, paid-for plan to finance SGR reform – and answer the $371 billion question once and for all.