SGR “gimmick” is holding health care back

Robert M. Wah, MD , Former President

You may have seen an article in the New York Times last week about the sustainable growth rate (SGR), a “budget gimmick that actually isn’t so bad.” To put it bluntly, I strongly disagree—it’s bad, really bad. It’s a charade that hides the real cost of Medicare and threatens to reduce access and choice for seniors. As a physician, I must point out the inaccuracy of the term "doc fix." Doctors do not need fixing—Medicare does. Eliminating the flawed SGR will be "fixing" Medicare.

Here’s the situation: Year after year, Congress extends a policy they agree is flawed by passing a temporary “payment patch” to override it. This continuous cycle of putting a Band-Aid on the real problem, creates an unpredictable environment that makes it difficult for physicians to budget and plan for practice innovations that could improve quality and reduce costs. It is also expensive. Congress has spent a staggering $170 billion on 17 patches in a 12-year period, the cost of which has far exceeded the cost of eliminating the SGR altogether.

We have less than two months until the current patch expires. As a country, we simply cannot afford to continue to perpetuate a system that is not meeting the needs of today’s American public. Patients and their physicians should not continue to be collateral damage caused by a failure to correct a flawed policy initiated by Congress. And articles like the one published in the New York Times are a detriment to our work, pushing misguided views about this policy that both Republicans and Democrats agree should be eliminated.

The bicameral, bipartisan bill that will, if passed, permanently eliminate the flawed formula also will put in place meaningful delivery and payment reforms that provide incentives for quality improvement, better care coordination and efforts to lower total health care spending. The continuation of the SGR is a huge barrier to the adoption of reforms that will improve the health of the nation and achieve substantial savings by reducing expenditures beyond the physician practice, such as hospital admissions, readmission, emergency department visits and post-acute services. The proposed bipartisan legislation to replace the SGR would accelerate a transformation in the Medicare program that will benefit patients and taxpayers as well as provide needed stability for physician practices.

The facts paint the real picture of the SGR: an expensive, irresponsible and stifling policy that is harmful to patients, the Medicare program and physician practices. America’s patients need their elected leaders to secure high-quality, cost-effective health care now and in the future. Congress must seize the moment by ending the SGR once and facilitating a path for delivery and payment reform.