SGR is Finally on its Way Out. Maybe.

Joe Cantlupe, for HealthLeaders Media , November 7, 2013

Although many bills designed to kill the sustainable growth rate formula have languished in Congress over the years, the talk these days is much more serious and physician groups have reason to be optimistic.

The government is still struggling with the fallout from the HealthCare.Gov fiasco, President Obama continues to explain to the confused masses how they will get insurance, and the U.S. is still waking up from a partial federal government shutdown.

While much is in disarray, particularly in healthcare, there is some irony here: The long-running physician payment scheme—aka the "doc fix"—might be on its way to being resolved for good (maybe).

For a decade, the SGR (sustainable growth rate formula) sets Medicare physician payment rates through a formula set in 1997. It has been the subject of an annual dance in Washington. The "doc fix," imposed by Congress to ward off potential cuts in the SGR, is scheduled to lower Medicare rates by 24.4% in 2014.

That drastic rate drop explains why when physicians are asked about one of their chief concerns and hopes in their practices, demolishing the detested SGR is virtually always at the top of their lists.

Although many bills designed to kill the SGR have languished in Congress over the years, the talk these days is much more serious. A so-called "discussion draft" released by the Senate Finance and Senate Ways and Means Committees last week would not only get rid of the SGR, but would also deliver value-based payment and delivery models to Medicare physician payment systems. It builds on a plan approved by the House Energy and Commerce committee.

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