In 1997 the Congress reformed how it pays physicians under Medicare. The new formula was termed the "sustainable growth rate" (SGR). The impetus for the reform was to control better Medicare cost growth. (Medicare physician payments now exceed $100 billion annually). Largely because of the concern physicians would limit seeing Medicare patients if their Medicare reimbursement rates were cut, the Congress has not enforced the SGR since 2002. Despite the realization the SGR is unalterably broken, the Congress has been unable or unwilling to amend the law. Though the upaid SGR tab is presently $138 billion this amount is substantially less than previous calculations that approached $300 billion (due to a recent decline in Medicare utilization). With debt and deficit reduction talks expected to re-emerge over the next few months will the Congress finally find the wherewithal to fix the docs?
The podcast begins with Dr. Berenson addressing the genesis of the SGR and then proceeding to explain why Congress has routinely ignored enforcing the SGR since 2002. The discussion proceeds to explain why/how doing away with the SGR would currently cost $138 billion. What effect the SGR has (still) had and what recent MedPAC and a bipartisan House proposal (Reps. Schwartz and Heck) call for in creating a new payment method while offsetting the accumulated $138 billion. Dr. Berenson next discusses his recent Congressional testimony where he identified ways to improve or mend Medicare fee for service payments, e.g., reducing distortions in, or improving the accuracy of, physician service relative value units (RVUs), improving payment for evaluation and management services. He argues in sum for global payment or partial capitation. Dr. Berenson concludes by noting current Congressional bi-partisan support for SGR reform though noting reform proposals would have to identify some mechanism/s to control for volume growth and an indication that quality and efficiency would be improved.
Dr. Robert Berenson is currently a Fellow at the Urban Institute where his research work concerns health care policy, particularly Medicare. From 1998-2000, Dr. Berenson was in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services (CMS). Previously, he served as an Assistant Director of the Carter White House Domestic Policy Staff. Dr. Berenson became a Commissioner of the Medicare Payment Advisory Commission (MedPAC) in 2009 and in 2010 became MedPAC's Vice Chair. Dr. Berenson is a board-certified internist, for the last twelve years practicing in Washington, D.C. He is Fellow of the American College of Physicians and the author of numerous research publications. He is a graduate of the Mount Sinai School of Medicine and on the faculty at the George Washington University Schools of Medicine and Public Health and the Fuqua School of Business at Duke.
Dr. Berenson's February 2013 Energy and Commerce Committee testimony can be found at: http://democrats.energycommerce.house.gov/sites/default/files/documents/Testimony-Berenson-Health-SGR-Medicare-Payment-2013-2-14.pdf
Dr. Berenson's (et al.) March 2013 Urban Institute paper, "Can Medicare Be Preserved While Reducing the Deficit?" is available at:http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/can-medicare-be-preserved-while-reducing-the-deficit-.html
Dr. Bob Berenson Discusses Possible Remedies for the Infamous Medicare "Doc Fix" (March 26, 2013)