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    Is an sustainable growth rate fix possible with the new Congress?


    Bob Gatty
    Washington—With a new, Republican-controlled House of Representatives and more GOP votes in the Senate, what are the chances of finally achieving a permanent fix of the Medicare fee schedule that has plagued urologists and every other physician who treats Medicare patients for years?

    The initial challenge for the lame-duck Congress is to pass another temporary reprieve for the total 24.9% cut that has been ordered by the Centers for Medicare & Medicaid Services (CMS), with the first 23% reduction slated to take effect Dec. 1 and the remainder a month later.

    But beyond that, the challenge is to find a way to solve the long-term fee schedule reform problem that now carries a price tag of some $300 billion.

    In announcing the cut, required under the sustainable growth rate (SGR) formula in current law, CMS noted that Congress has provided temporary relief from such reductions every year since 2003, and "a long-term solution is critical."

    "Broad physician participation in Medicare is essential to ensuring that beneficiaries continue to have access to care, and physician engagement is critical to our efforts to strengthen the quality of care," said CMS Administrator Donald Berwick, MD. "Medicare needs to be a strong, dependable partner with physicians—and that means the SGR must be fixed. The administration supports permanently reforming the Medicare payment formula."

    "Everybody agrees it needs to be fixed," observed Karen Lencoski, JD, MBA, government relations and advocacy manager at the AUA. "The question is, where do you find the money?"

    Still, Lencoski expressed optimism that Congress will find the courage to tackle the Medicare payment crisis, which threatens to discourage increasing numbers of physicians from treating Medicare patients because of the uncertainty surrounding payment levels that even now, in many cases, do not adequately cover costs—let alone account for inflation.

    "I actually feel hopeful," she told Urology Times. "I think there will be new energy in this Congress. The president has indicated a willingness to work together with Republicans. Hopefully, that will happen. We need some kind of stability for urologists. This past year was very difficult, with everything changing every couple of months."

    Lencoski was hoping that the lame-duck session would result in a 13-month reprieve to provide time to develop a long-term solution. Failing that, she hopes the new Congress will adopt at least a 1-year fix to provide time to achieve permanent reform.

    Docs must work together

    But to accomplish that, Lencoski believes all of the groups with a stake in the outcome, including the AUA, the American Medical Association, the American College of Surgeons, the Alliance of Specialty Medicine, and many others need to cooperatively work with lawmakers to find the answer.

    "We all need to work together. These series of patches just can't go on forever," she said, adding that the organizations representing physicians should cooperatively develop a recommended payment model for Congress to consider.

    The day after the election, the Alliance of Specialty Medicine, of which the AUA is a member, issued a statement expressing hope that positive change can be achieved.

    "We hope that Congress's newly elected members will bring a fresh outlook on how to approach health care issues facing this country," said Alex B. Valadka, MD, a neurologic surgeon and spokesperson for the Alliance. "First on their lists should be providing a permanent fix to the outdated Medicare reimbursement formula, repealing the Independent Payment Advisory Board (IPAB), and bringing real reform to the medical liability system."

    The IPAB, to be established under the new health reform law, has been targeted by the AUA, the AMA, and other physician groups for repeal. In mid-September, the Alliance wrote to the National Commission on Fiscal Responsibility and Reform, the bipartisan entity established by President Obama to develop recommendations to reduce the federal deficit, urging the commission not to give the IPAB any more power and to develop an alternative that provides a long-term solution for the fee schedule crisis.

    "Each year that Congress fails to act, the problem only gets worse," the Alliance said, noting that the net cost for providing December 2010 payments at the 2009 level for 2011 through 2020—allowing for an inflationary update—would be $330 billion.

    That, of course, is the problem and, no doubt, will continue to be the problem.

    Health reform repeal imminent?

    Many Republicans, in their campaigns prior to the Nov. 2 election, promised to repeal the Patient Protection and Affordable Care Act, and the new House Majority Leader, John Boehner (R-OH), has said it will be one of the party's top priorities, along with cutting federal spending.

    While it is doubtful the GOP could get complete repeal through the Senate and most certainly would not be able to override an Obama veto, it will not be surprising to see this new Congress try to repeal specific provisions, possibly using that strategy to help pay for a Medicare fee schedule solution.

    "Right now," said Lencoski, "it's too early to tell what will happen. But we are looking forward to working with some of these new people, and I hope things will change."

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

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

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