SGR: The Not “Sustainable Growth Rate”
In 1997, Congress created the Sustainable Growth Rate (SGR), a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, in just a few short years, health-care costs far outpaced economic growth, which created a multi-billion dollar shortfall in funding for Medicare payments. Since 2003, Congress has approved “doc fix” bills that appropriate more money to Medicare funding in order to avoid cuts in the Medicare reimbursement rates for doctors. Recently, Congress passed a ‘doc fix’ bill for the 17th time in 11 years. In essence, kicking the can down the road once again.
The Medicare Sustainable Growth Rate (SGR) payment system to physicians was never sustainable, never a growth rate and always unfairly discriminatory against physicians. How physicians have been able to keep their doors open to Medicare patients for so long while under a 13-year price freeze when practice expenses have skyrocketed is only answerable by the altruism and personal commitment that doctors have for their patients.
The problem going forward with Congressional compromise and wheeler-dealer arrangements in replacing the SGR is simply that future reimbursements may be based on compliance requirements and so-called quality measures that have unproven clinical relevance and may be more costly than helpful. It is laudable that when Congress passed the Medicare Act (Title XVIII) in the 1960s, the original language specifically said: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee.” It is distressing to see the absolute disregard of that principle as Congress and the Executive Branch take every opportunity to interpose themselves between the patient and the doctor. Those who have neither a license to practice medicine nor the education to deliver medical care seem to take pleasure in the erosion of physician autonomy and medical decisions, which should be based on the individual needs of the patient rather than on a bureaucratic practice or cost parameter.
While progress has been made in reaching a bipartisan agreement to repeal the Sustainable Growth Rate (SGR), Congress must continue to work to resolve outstanding issues. Congress needs to treat physicians fairly and stop undervaluing our needed services to patients. And we, as physicians, need to continue to fight, to be vocal and to take a leadership role in SGR reform.
Dr. Russell Kridel is a Houston-based Facial Plastic Surgeon in private practice in the Texas Medical Center.
Click here for additional comments on SGR and government red tape from one of Dr. Kridel’s HCMS president’s editorial.