It is unlikely that additional action will be taken on The Medicare Physician Payment Innovation Act of 2012 (H.R. 5707) in the near future. Democratic Minority Leader Nancy Pelosi (D-CA) is supportive of efforts for sustainable growth rate (SGR) repeal, although she is not listed as a sponsor or co-sponsor of this legislation.[1] [2] Likewise, Congressman Earl Blumenauer (D-OR) is the only Democratic co-sponsor from the Ways and Means Committee, as co-sponsorship from Ranking Member Congressman Sander Levin (D-MI) and Congressman Charles Rangel (D-NY), Ways and Means Committee Chairman Emeritus, are notably absent. Additionally, there is no sponsorship from Congressman Henry Waxman (D-CA), Ranking Member of the House Energy and Commerce Committee.[3] However, none of these sponsorship absences are absolute confirmation that influential Democrats are not supportive of the legislation.[4]
Currently, Congressman Heck is the only Republican sponsor of H.R. 5707 in a Republican-controlled Congress.[5] This does not necessarily mean that there is not additional interest in this issue on the right side of the aisle. Representative Michael Burgess, a Republican legislator from Texas who currently serves as the chair of the Congressional Health Care Caucus, believes that more information is needed about the proposed legislation before moving forward. Additionally, the bill is likely too costly for legislators of either party to endorse, and in recent weeks Republicans have become less receptive to H.R. 5707 in favor of exploring cuts to other area of the budget, instead.[6] [7]
The Senate Finance Committee would most likely deal with SGR legislation that is introduced in the Senate or referred from the House of Representatives. H.R.5707 has not yet progressed to this point. However, despite numerous hearings on SGR modification and repeal with the most recent hearings having occurred this past summer (2012) in the Ways and Means Committee and the Senate Finance Committee no lasting solutions have been adopted.[8] [9] [10]
Alternative Temporary and Permanent Solutions for the SGR Crisis
Several other proposals for eliminating or lessening the detrimental impact of the SGR have been recently proposed. Representative Michael Burgess introduced H.R.6142, the “Assuring Medicare Stability and Access for Seniors Act of 2012,” in the 112th Congress on July 18, 2012, to repeal the SGR for calendar year 2013. Four Republican House members co-sponsored the bill before it was transferred to the health subcommittees of the House Ways and Means and Energy and Commerce Committees a few days prior to the August 2012 recess.[11] Again, at this time due to the looming fiscal cliff crisis, passage prior to January 2013 is uncertain. A second attempt at resolving the SGR was initiated by Senator Rand Paul from Kentucky. Like Representative Burgess, Senator Paul is a physician who believed that the “doc fix” dilemma could be resolved prior to January 2013 through S.3337, the “Access to Physicians in Medicare Act of 2012.” The goal of his legislation is to finance SGR repeal by eliminating Medicaid expansion and premium subsidy payments in the Patient Protection and Affordable Care Act (PPACA). Medicare payments to physicians would then modestly increase. The bill has very little chance of passing the Senate, as it received no co-sponsorship prior to its referral to the Senate Finance Committee in June 2012.[12] [13] Furthermore, neither Senate Majority Leader Harry Reid nor President Barack Obama deem the bill suitable for consideration due to its unacceptable language of sacrificing a key provision of the PPACA to fund SGR repeal.[14]
Other proposals for short-term resolution have been offered by the AMA, MedPAC, the Obama administration, and Bowles-Simpson, a national commission charged with offering suggestions for improving the nation’s fiscal health. All of these plans involve some type of short-term freeze and/or reduction on physician reimbursements for time periods ranging from 5-10 years with an eventual return to SGR utilization. Implementation costs for all of these plans is over $200 billion dollars.[15] [16]
Conclusion
Congressional elections have not shifted the balance of power in the House or the Senate, although party leadership will largely determine the course of action for H.R. 5707 over the next few months. It is possible that the issue of SGR repeal will be undertaken in a lame duck session of Congress. However, time is dwindling for that option, and with the fiscal cliff situation still unresolved, the death of this bill is a very real possibility as the new Congress re-convenes on January 3, 2013. If this happens, then Congressional leaders will have to decide whether or not they wish to resurrect H.R. 5707 in the 113th Congress. Should they decide not to do so, lawmakers may have to essentially go “back to the drawing board” and think of new ways to stop the acceleration of reimbursement cuts while Medicare physician service costs continue to balloon. Expectations of what can be feasibly accomplished in the meantime must also be reasonably managed.
Despite all of this, a successful permanent resolution of the SGR problem must occur, as temporary stopgap measures are no longer sufficient. It is in the best interest of Congress and all Americans potentially affected by this crisis to ensure that the situation is resolved sooner rather than later. Delaying the problem would only increase cost substantially, as The Congressional Budget Office estimates that the cost of eliminating the SGR is expected to continue to skyrocket to over $245 billion over the next 10 years (by 2022) if the problem is not promptly addressed.[17] [18]
Dorkina Myrick, MD, PhD, is a physician-scientist and pathologist trained at the National Institutes of Health. Dr. Myrick also previously served as a Health Policy Advisor in the United States Senate and the United States House of Representatives.
References
[1] Schwartz, Allyson Y. (PA-13). “H.R. 5707-Medicare Physician Payment Innovation Act of 2012.” Bill Summary and Status, All Information. 112th Congress (2011-2012). Thomas. 9 May 2012. Web. http://hdl.loc.gov/loc.uscongress/legislation.112hr5707. 19 October 2012.
[2] Pelosi, Nancy. “Transcript of Pelosi Press Conference Today.” Democratic Leader Nancy Pelosi Press Release. 18 January 2012. Web. 22 October 2012. http://www.democraticleader.gov/news/press?id=2458.
[3] Schwartz, Allyson Y. (PA-13). “H.R. 5707-Medicare Physician Payment Innovation Act of 2012.” Bill Summary and Status, All Information. 112th Congress (2011-2012). Thomas. 9 May 2012. Web. http://hdl.loc.gov/loc.uscongress/legislation.112hr5707. 19 October 2012.
[4] Letter to Reps. John Boehner (R-OH), Nancy Pelosi (D-CA); Senators Harry Reid (D-NV), and Mitch McConnell (R-Ky). 16 April 2012. Web. 22 October 2012. http://www.facs.org/ahp/medicare/sgr-repeal-letter041612.pdf.
[5] Heck, Joe. House of Representatives Website. Web. http://heck.house.gov/about-me/full-biography. 6 December 2012.
[6] Lowes, Robert. “1-Year Medicare ‘Doc Fix’ Looks to Avoid ‘Fiscal Cliff’.” Medscape Medical News. July 24, 2012. Web. http://www.medscape.com/viewarticle/768033 . 8 December 2012.
[7] Fiegl, Charles. “Medicare SGR sticker shock adds urgency to pay reform campaign.” American Medical News. 3 December 2012. Web. http://www.ama-assn.org/amednews/2012/12/03/gvl11203.htm. 12 December 2012.
[8] Schwartz, Allyson Y. (PA-13). “H.R. 5707-Medicare Physician Payment Innovation Act of 2012.” Bill Summary and Status, All Information. 112th Congress (2011-2012). Thomas. 9 May 2012. Web. http://hdl.loc.gov/loc.uscongress/legislation.112hr5707. 19 October 2012.
[9] Herger, Wally. “Herger Opening Statement: Hearing on Physician Organization Efforts to Promote High Quality Care and Implications for Medicare Physician Payment Reform.” Ways and Means Committee Hearing Press Release. 24 July 2012. Print. Web. http://waysandmeans.house.gov/news/documentsingle.aspx?DocumentID=304210. 22 October 2012.
[10] Baucus, Max. “Roundtable Statement of Senator Max Baucus (D-Mont.) Regarding the Medicare Physician Payment System.” Senate Finance Committee Hearing Press Release. 11 July 2012. Print. Web.
http://www.finance.senate.gov/imo/media/doc/07112012%20Baucus%20Talks%20with %20Physicians%20about%20Medicare%20Payment%20System1.pdf. 22 October 2012.
[11] Burgess, Michael. “H.R.6142-Assuring Medicare Stability and Access for Seniors Act of 2012.” Bill Summary and Status, All Information. 112th Congress (2011-2012). Thomas. 18 July 2012. Web. 9 December 2012. http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.6142:Retrieved 12-9-2012.
[12] Paul, Rand. Senate Official Website. Web. 9 December 2012. http://www.paul.senate.gov/?p=about_senator.
[13] Paul, Rand. “S.3337-Access to Physicians in Medicare Act of 2012.” Bill Summary and Status, All Information. 112th Congress (2011-2012). Thomas. 25 June 2012. Web. http://thomas.loc.gov/cgi-bin/query/z?c112:S.+3337: 12 December 2012.
[14] Lowes, Robert. “1-Year Medicare ‘Doc Fix’ Looks to Avoid ‘Fiscal Cliff’.” Medscape Medical News. July 24, 2012. Web. http://www.medscape.com/viewarticle/768033. 8 December 2012.
[15] Keckley, Paul H.; Walker, Jennifer; Gostine, Andrew; Pulde, Sasha. “Understanding the SGR-Analyzing the ‘Doc Fix’.” Deloitte Center for Health Solutions. Web. http://www.deloitte.com/view/en_US/us/Insights/centers/center-for-health-solutions/f4bcd1c4c837a310VgnVCM3000003456f70aRCRD.html. 8 December 2012.
[16] “Update: Medicare’s Payments to Physicians: The Budgetary Impact of Alternative Policies.” Congressional Budget Office. Web. http://www.cbo.gov/publication/43502. 21 November 2012.
[17] “Medicare’s Payments to Physicians: The Budgetary Impact of Alternative Policies Relative to CBO’s March 2012 Baseline.” Congressional Budget Office. Print. 30 July 2012. (Updated 1 November 2012) Web. http://www.cbo.gov/publication/43502. 9 December 2012.
[18] Aizenman, N.C. “Medicare’s ‘SGR’ Formula Has Snowballed to Budget-Busting Juggernaut.” The Washington Post. 15 December 2011. Web. http://www.washingtonpost.com/national/healthscience/medicares-sgr-formula-has-snowballed-to-budget-busting-juggernaut/2011/12/13/gIQAXaq3wO_story.html. 21 October 2012.
Reflections and Analysis in Law, Policy and Medicine 