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SGR delay does little to mollify medical societies' ire

by Brendon Nafziger, DOTmed News Associate Editor | January 02, 2013
The last-minute fiscal cliff compromise reached by Congress on New Year's Day also includes a freeze in the nearly 27 percent cut in Medicare reimbursements to physicians that would otherwise go into effect this month, but leading medical societies say Congress is still playing kick-the-can with a wrongheaded policy.

The fiscal cliff compromise package, the American Taxpayer Relief Act, was approved late on Jan. 1 by the House, after sailing through the Senate. Among its many provisions is a one-year freeze on 26.5 percent Medicare cuts called for by the sustainable growth rate formula. The bill also delays by two months the 2 percent sequestration cuts in Medicare to hospitals and providers, presumably to give Congress time to try to work out a longer-lasting deal.

But not everyone's breaking out the champagne. For one, the SGR patch lasts only another year, which means as 2014 approaches we could be having this conversation all over again. Plus, to help raise the $25 billion needed to pay for the stopgap measure and related Medicare elements in the bill, Congress included a massive $800 billion cut to advanced imaging services and $300 billion to radiation therapy over the next decade.
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Naturally, the imaging cuts drew a furious reaction from groups representing radiologists. In a statement, Dr. Bibb Allen Jr., vice chair of the board of chancellors of The American College of Radiology, called the imaging cuts "incredibly shortsighted and unnecessary" and faulted Washington for its "lack of vision" and "lack of leadership." Dr. Paul Ellenbogen, the chair of ACR's board, was equally excoriating, lamenting that Capitol Hill was "an environment that resembles more 'Alice in Wonderland' than 'Mr. Smith Goes to Washington,'" and saying the move was "an embarrassment to our country and a disservice to our nation's seniors" as well as "a step backward in patient care."

For its part, ASTRO, which represents radiation oncologists, said it was "concerned" by the radiation therapy cuts. The cuts primarily involve lowering hospital outpatient payments for radiosurgery that uses Cobalt 60, which ASTRO chair Dr. Michael L. Steinberg called "arbitrary." He also said the cuts are not based on the hospital-reported cost information the outpatient payment system typically uses, and that they're worried that the "policy change ignores this long-standing, accepted process."

The American Medical Association, which has long campaigned against the SGR — and even featured a doomsday-style countdown clock on its website for the days leading up to the cuts — was still unhappy that a total repeal has not been realized yet. "This patch temporarily alleviates the problem, but Congress' work is not complete," AMA president Dr. Jeremy A. Lazarus said on the group's website. He went on to warn that the "last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients," and that such instability "stalls progress in moving Medicare toward new health care delivery models that can improve value for patients through better care coordination."

MGMA-ACMPE, a society for administrators of medical group practices, shared AMA's concerns. In a statement, the group's president and CEO, Susan L. Turney, said the "11th hour" action to avert the cuts merely "perpetuates another year of uncertainty for physician practices forced to continue their work under the dark cloud of looming SGR cuts and the new threat of sequestration cuts scheduled for March."

"Physician practices need a stable, predictable Medicare payment system to allow them to make sound, long-term decisions to invest in their practices, position themselves for the future, and provide the highest quality care to the Medicare patients they serve," she said.

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