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    Could GOP majority scuttle SGR reform?

    AUA believes permanent solution is possible before March 31

    Bob GattyBob GattyWashingtonOnce again, urologists and other physicians whose practices are heavily reliant upon Medicare payments for patient care will soon face another potential crisis as a 21.2% reduction in the sustainable growth rate (SGR) formula, on which payments are based, is set to take effect March 31.

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    In April, President Obama signed legislation averting a 24% cut, after approval by the Republican-controlled House of Representatives and the Democrat-controlled Senate. It was the 17th time Congress had stepped in with a short-term measure to block scheduled physician cuts.

    Congress again faces the same challenge, but this time the dynamics are different as Republicans have gained seats in the House and are in firm control in the Senate, where only 16 GOP senators supported last year’s fix and where there were insufficient votes to approve a permanent solution that would have increased Medicare payments by 0.5% annually for the next 5 years. Lawmakers, principally Republicans, could not agree on how to finance the $120 billion price tag of permanently eliminating those cuts.

    Optimism on SGR reform in 2015

    So now, with the GOP even more firmly entrenched on Capitol Hill, how can a solution be possible?

    “I do not think having a Republican-controlled Congress means SGR reform is dead. Even if it isn’t addressed in the lame-duck session, we still have until March 31 to get it done,” said James Ulchaker, MD, chairman of the AUA’s Legislative Affairs Committee.

    The AUA and its allies are working Capitol Hill now hoping to convince lawmakers in the post-election “lame duck” to provide a permanent solution to this annual problem. But Dr. Ulchaker and Brad Stine, the AUA’s director of government relations, believe that if that effort fails, there will be an opportunity for success early in 2015.

    “Even a temporary fix costs money,” Stine observed. “But folks in Congress are tired of doing the patches. This problem wears on members up there. There is a lot of support for getting this resolved.”

    Still, Republicans believe they were sent to Congress to “get spending under control,” and one of the most forceful advocates for reducing Medicare costs, Rep. Paul Ryan (D-WI), is expected to chair the House Ways and Means Committee, which would put him in a position to have enormous influence over what happens with Medicare. In fact, there has been speculation that Ryan may try to tie an SGR solution to broader, more ambitious Medicare reforms.

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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