ANOTHER SGR REPEAL FAILS;
WE MUST FACE THE MOUNTAIN AGAIN
Gordon R. Tobin, MD
AN ACCUMULATING
INJUSTICE
Intense efforts for over a decade to repeal
the faulted Sustainable Growth Rate (SGR)
formula for physician services to Medicare
patients have repeatedly been denied by Congress. Amidst this, in 2003, Congress opened
unfunded cash-flow spigots to investor-owned
insurance corporations (Medicare Advantage
Plans) and pharmaceutical corporations (no-bid drug benefits),
as physicians continued to face scheduled annual payment cuts
of about 5.5 percent. To prevent physician exodus from Medicare
participation, these cuts were deferred by sequential short-term
“patches,” which failed to keep up with practice expense increases
and created a massive accumulating physician payment cut (now 24
percent).1 This spring, another repeal effort was denied by partisan
Congressional intransigence, and another 1-year “patch” was again
required. This cyclical, tragic farce has come to resemble the ancient
Greek myth of King Sisyphus, who was fated to push a heavy boulder repeatedly up a steep mountain, only to have it escape before
reaching the top and tumble back to the valley floor (Fig. 1).
SG
RE R
PE
A
L
ANOTHER CORRECTION ATTEMPT
More than any previous attempt, the efforts of organized medicine
and other patient advocates this spring seemed hopeful of reaching
the summit of permanent SGR repeal. A path of opportunity appeared in 2013 from the effect of recent decreases in overall health
spending on the SGR formula, which lowered the calculated cost of
permanent repeal to under half the cost of just two years ago. The
American Medical Association and virtually all specialty societies
made a united press for SGR repeal.2 A year-long, collaborative
effort between key medical stakeholders and Congress resulted in
an initial bipartisan, bicameral agreement for SGR repeal before
the existing patch expired on April 1. Hopes were high, but the
agreement collapsed at the last minute under the forces of partisan,
ideological politics, and the boulder rolled back down the mountain
once again.
POISONOUS POLITICS
The events of the collapse are summarized in the June 2014 Bulletin
of the American College of Surgeons titled, “The SGR Repeal: How
Bad Politics Ruined Sound Policy.3” The effort failed principally
due to irresolvable funding disputes between House (H.R. 4015)
and Senate (S.2000) versions of the bill, which split over funding
sources to offset the repeal cost. A Senate majority selected offset
funding drawn from the Oversees Contingency Operating funds,
but this lacked the 60 votes necessary to defeat a filibuster. The
House majority added a last-minute amendment to fund the bill
by a five-year delay (to 2018