Congress likely to approve
one-year SGR extension

posted 12.13.11

As Congress prepares to wrap up work before the holidays, there are several pending pieces of legislation that may delay their departure, including the extension of the Medicare Physician Fee Schedule. Without Congressional action, physicians will receive a 27.4 percent cut in their Medicare payment as the broken sustainable growth rate formula goes into effect on Jan. 1, 2012. AAFP reports that Congress will likely pass a single-year extension of the SGR, perhaps with a small increase.

The House of Representatives is expected to propose a two-year extension of the SGR with a 1 percent increase. The Congressional Budget Office estimates that the proposal would cost about $40 billion over 10 years by repealing or scaling back programs authorized by the Affordable Care Act, like the CMS Innovation Center (responsible for testing alternative payment models) and the Prevention and Public Health Fund (that supports tobacco control and other public health initiatives).

The Senate is likely to reject this House version of a “doc fix” and instead propose a single-year extension with a small increase paid for with non-controversial offsets. However, AAFP reports that a small bipartisan group of senators is trying to develop a proposal for a longer-term fee schedule update of five to 10 years. The cost of such a proposal is significant, and these senators are considering using the discretionary funds dedicated for military operations in the Middle East. As such, this offset is unacceptable to many in the House of Representatives and the one-year extension is seen as more palatable.

Since this summer when the Joint Select Committee on Deficit Reduction, or “supercommittee,” was formed, AAFP has been consistent in asking Congress to repeal the SGR; provide three to five years of specified, stable payments during which new payment models would be tested; and build in a higher fee-for-service payment rate for primary care physicians who offer primary care services.

AAFP state chapters that had representatives or senators on the supercommittee wrote letters to their legislators, and several arranged meetings with them in their home states or Washington, D.C., to support AAFP’s position. And later in the fall, AAFP leaders traveled to Washington on two occasions to meet with congressional leaders for the same purpose.

With the help of AAFP members, the Academy mounted a significant grassroots advocacy campaign for SGR repeal. This included AAFP Congress of Delegates members sending a coordinated message to Congress, soliciting personal stories from members about their practice and training experiences to use as the foundation for the campaign’s messaging, and developing the “Family Medicine Matters” video series featuring AAFP President Glen Stream, M.D., M.B.I. As a result of these efforts, 2,267 AAFP members sent 5,554 letters to lawmakers.

AAFP continues to monitor actions in Congress, urging legislators to craft a solution to the SGR that includes a period of stable positive payments in which primary care physicians are paid at a rate at least 3 percent higher than non-primary care physicians. Academy leaders will reiterate to Congressional leaders that a modest two-year payment increase is better than a 27.4 percent cut, but that Congress is making the problem of the SGR worse and increasing the cost of fixing it. Stay tuned for developments in the weeks ahead.