02 June 2010

Innovative Ideas for the SGR

This is something I have not seen reported on elsewhere, but according to ACEP's 911 legislative network, there was an interesting twist in the Democrats' proposed SGR fix:
The latest plan increases physician payments by 1.3% for the remainder of this year and by an additional 1% in 2011. In 2012 and 2013, physician services would be separated into two categories, or "buckets." One bucket would be for E&M services (including emergency department, primary and preventive care) and the other group would include all other services. The E&M bucket would increase at the same rate as the U.S. gross domestic product (GDP) plus 2%, while the other group would receive a payment increase of GDP plus 1%.

After 2013, the payment formula would revert back to the current SGR formula, which means physicians would face cuts in the range of 30-35% unless Congress intervenes.

So it's another temporary fix, kicking the can past the next presidential election.

But it's the first one I have seen which attempts to address the gross disparity in reimbursement for procedural services compared to the cognitive services.  It bypasses the RUC and bypasses almost every other extant mechanism for determining reimbursement under the MPFS. I'm not sure what happened with this proposal.  I don't think it was in the version of legislation the House passed, so I think it might be dead.  But the situation is so in flux that who really knows?

If nothing else, it's an encouraging sign that policymakers know the problem exists and are willing to throw out possible solutions.  This one may be dead, but it's a good start.

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