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Healthy Vision 2020
Bringing into focus a clear and distinct view of the rest of this decade in Texas health care. Offering a sharp perception of what lies ahead and what we must change to keep us all healthy.
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Baucus, Hatch Call for Medicare Physician Payment System Improvements

Texas Medical Association's insight:

Stop the Medicare Meltdown — repeal the SGR

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.

 

Medicare patients and military families are never out of danger. Year after year, the specter of congressional action or lack of action threatens to jeopardize health care for Medicare patients. And, because TRICARE rates for military families are based on Medicare, they’re in danger, too.

 

This is because federal law requires Medicare payments to physicians to be modified annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. It took emergency action in December 2011 and again in February 2012 to stop a 27.4-percent cut. That would have meant an annual loss of $1.71 billion to physicians for the care of elderly patients and Texans with disabilities.

 

Most commercial insurers pay physicians based on a percentage of the Medicare rate, which has changed little over the past decade. This double hit has meant a flat-lining of physician payment rates that threatens the viability of many physician practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.

 

Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.

 

Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.

 

Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.

 

Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”

 

We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.

 

Medicare patients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work.

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House GOP releases revised proposal for replacing SGR

House GOP releases revised proposal for replacing SGR | Healthy Vision 2020 | Scoop.it
House GOP leaders released a revised proposal to replace Medicare's SGR physician payment formula with a system that includes specialty-specific performance measures.
Texas Medical Association's insight:

Stop the Medicare Meltdown — repeal the SGR

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.

 

Medicare patients and military families are never out of danger. Year after year, the specter of congressional action or lack of action threatens to jeopardize health care for Medicare patients. And, because TRICARE rates for military families are based on Medicare, they’re in danger, too.

 

This is because federal law requires Medicare payments to physicians to be modified annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. It took emergency action in December 2011 and again in February 2012 to stop a 27.4-percent cut. That would have meant an annual loss of $1.71 billion to physicians for the care of elderly patients and Texans with disabilities.

 

Most commercial insurers pay physicians based on a percentage of the Medicare rate, which has changed little over the past decade. This double hit has meant a flat-lining of physician payment rates that threatens the viability of many physician practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.

 

Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.

 

Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.

 

Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.

 

Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”

 

We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.

 

Medicare patients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work.

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Deloitte | Understanding the SGR: Analyzing the “Doc Fix” | New Issue Brief examines debate around Medicare physician payments

Deloitte | Understanding the SGR: Analyzing the “Doc Fix” | New Issue Brief examines debate around Medicare physician payments | Healthy Vision 2020 | Scoop.it

The debate around Medicare Part B’s Sustainable Growth Rate (SGR) is important to short-term policy-making around physician payments and longer-term issues...

 

TMA Says:

 

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.

 

Medicare patients and military families are never out of danger. Year after year, the specter of congressional action or lack of action threatens to jeopardize health care for Medicare patients. And, because TRICARE rates for military families are based on Medicare, they’re in danger, too.

 

This is because federal law requires Medicare payments to physicians to be modified annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. It took emergency action in December 2011 and again in February 2012 to stop a 27.4-percent cut. That would have meant an annual loss of $1.71 billion to physicians for the care of elderly patients and Texans with disabilities.

 

Most commercial insurers pay physicians based on a percentage of the Medicare rate, which has changed little over the past decade. This double hit has meant a flat-lining of physician payment rates that threatens the viability of many physician practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.

 

Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.

 

Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.[i]

 

Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.[ii]

 

Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”

 

We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.

 

Medicare patients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work.


[i] American Medical Association.  Now Is The Time To Repeal The SGR. 2012. Available at http://www.ama-assn.org/resources/doc/washington/now-is-the-time-to-repeal-sgr.pdf. Accessed April 2012.

[ii] Texas Medical Association. Survey Results for Texas Medical Association Medicare SGR Survey. August 2011. Available at http://www.texmed.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=22531&libID=20171. Accessed April 2012.

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House Bill to Press for One-Year SGR Delay

House Bill to Press for One-Year SGR Delay | Healthy Vision 2020 | Scoop.it

If passed, the delay in implementation of the sustainable growth rate formula would allow Congress to get past the uncertainties presented by the up...

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work. TMA's proposals:

- Repeal the broken SGR. Enact a rational Medicare physician payment system that works and is backed by a fair, stable funding formula.

- Fix the broken Medicare physician payment system before giving additional increases to any other providers.

 

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Physicians Ask Congress for SGR Alternatives

Physicians Ask Congress for SGR Alternatives | Healthy Vision 2020 | Scoop.it

Doctors’ advocates are asking Congress to scrap Medicare’s widely reviled sustainable growth rate payment scheme and replace it with fle...

 

For decades, physicians have given away their services for free to patients who could not afford to pay. However, today’s health care market makes this very difficult. Medicare and Medicaid, which now cover 35 percent of health care in America,  often pay physicians less than it costs them to provide their services. Commercial insurance companies’ payment rates, computed largely as a percentage of Medicare, have followed the government-run programs into the basement. The nation’s 50 million uninsured, including 6.2 million Texans,  can rarely pay the costs of their health care. The squeeze leaves many physicians struggling to keep their practices open, let alone provide charity care. State and federal leaders must realize that cutting physicians’ payments is not an effective tool for controlling health care costs, and often exacerbates the cost of care. They also must realize that without physicians, no health care delivery system can be effective 

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SGR Ripe for Repeal, Where’s Congress?

"Physician groups say the time is finally right for lawmakers to overhaul the disdained sustainable growth-rate formula. But no one in Congress is embracing a specific plan, and the funding possibilities are uncertain."

Texas Medical Association's insight:

Stop the Medicare Meltdown — repeal the SGR

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.

 

Medicare patients and military families are never out of danger. Year after year, the specter of congressional action or lack of action threatens to jeopardize health care for Medicare patients. And, because TRICARE rates for military families are based on Medicare, they’re in danger, too.

 

This is because federal law requires Medicare payments to physicians to be modified annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. It took emergency action in December 2011 and again in February 2012 to stop a 27.4-percent cut. That would have meant an annual loss of $1.71 billion to physicians for the care of elderly patients and Texans with disabilities.

 

Most commercial insurers pay physicians based on a percentage of the Medicare rate, which has changed little over the past decade. This double hit has meant a flat-lining of physician payment rates that threatens the viability of many physician practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.

 

Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.

 

Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.

 

Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.

 

Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”

 

We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.

 

Medicare patients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work.

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End the 'doc fix' charade, once and for all

End the 'doc fix' charade, once and for all | Healthy Vision 2020 | Scoop.it
Doctors are breathing a collective sigh of relief because we again escaped a cut in Medicare payments. But this whole recurrent charade underscores, once again, the unresolved issue of how to pay doctors.
Texas Medical Association's insight:

Stop the Medicare Meltdown — repeal the SGR

 

Since the turn of the century, nothing has so regularly and completely vexed and frustrated physicians more than our annual game of chicken with Congress over Medicare payments.

 

Medicare patients and military families are never out of danger. Year after year, the specter of congressional action or lack of action threatens to jeopardize health care for Medicare patients. And, because TRICARE rates for military families are based on Medicare, they’re in danger, too.

 

This is because federal law requires Medicare payments to physicians to be modified annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the formula has mandated physician fee cuts every year for the past decade. Only short-term congressional fixes have stopped the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. It took emergency action in December 2011 and again in February 2012 to stop a 27.4-percent cut. That would have meant an annual loss of $1.71 billion to physicians for the care of elderly patients and Texans with disabilities.

 

Most commercial insurers pay physicians based on a percentage of the Medicare rate, which has changed little over the past decade. This double hit has meant a flat-lining of physician payment rates that threatens the viability of many physician practices and makes investment in new clinical equipment and health information technology increasingly more difficult and challenging.

 

Because Congress once again failed to repeal the SGR, the Congressional Budget Office projects that the next cut, scheduled for Jan. 1, 2013, will be approximately 30 percent. Without a permanent solution, the size of the cuts continues to grow.

 

Instead of fixing the flawed formula, Congress freezes the cut each year. In essence, Congress has put the SGR debt on our credit card. The 10-year cost of fixing the problem is now well over $300 billion.100

 

Considering that Medicare currently pays, on average, at least 20 percent less than a physician’s cost to provide care, this decade-long and continued uncertainty is forcing some physicians to make the difficult decision to either opt out of Medicare, limit the number of patients they treat, or retire early. A recent TMA survey indicates that 50 percent of Texas physicians are considering opting out of the Medicare program altogether.101

 

Medicare patients often can’t get in to see their physicians as quickly as needed. This forces Medicare patients to put off care until they are so sick they need to use a hospital’s ED, which is more expensive. Sending a Medicare patient to the ED is counterproductive to the goal set by Congress and the White House to keep health care costs down by encouraging all Americans to have a “medical home.”

 

We all recognize the value that hospitals, nursing homes, home health services, durable medical equipment, and other health care providers give to Medicare patients. Over the past decade, they have received annual payment increases, while physicians have not.

 

Medicare patients should feel anything but secure about the future of their health care. Physicians are the foundation of the Medicare program. Without a robust network of physicians to care for the millions of patients dependent on Medicare, the program will not work.

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Six Main Reasons Physicians Are Dropping Medicare Patients

"September 1, 2012 is the current deadline for physicians who wish to opt out of Medicare —and record numbers are doing just that. According to a recent survey by the Texas Medical Association, the number of Texas physicians accepting Medicare patients dropped from 78 percent in 2000, to 58 percent in 2012. Texas is one of the few states that keeps Medicare opt-out information. HHS' Office of Inspector General (OIG) in January reported it couldn't pin down the extent of the problem nationally because Medicare and its contractors don't keep adequate data on physicians who opt out.

Why are so many physicians opting out of Medicare?"

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Don’t Count on SGR Reform This Year

Don’t Count on SGR Reform This Year | Healthy Vision 2020 | Scoop.it

While the U.S.House Ways and Means Committee is seeking input from physician groups about ideas for the controversial sustainable growth rate formula...

 

The definition of insanity is doing the same thing over and over in expectation of a different result. We've been calling on Congress to do away with the flawed Medicare payment formula for more than a decade. They always say they should. Then they run us up against a cliff and "kick the can down the road" again. This should have been taken care of in the Patient Protection and Affordable Care Act. Call us crazy -- we're pushing for SGR repeal, again. 

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