Congress is as close as it has ever been to scrapping the Medicare sustainable growth rate (SGR) for an alternative system of paying doctors based on the quality – rather than the quantity – of services.
The SGR system has been in place since 1997, and every year since 2002 Congress has passed legislation to temporarily delay reductions in physician payments. In December, Congress passed only a three-month stay on a scheduled 24 percent cut to give lawmakers time to fashion a permanent fix to the flawed payment system early in 2014.
The briefing examined alternative payment and delivery system models that have promise as replacements.
Should physicians participating in alternative delivery systems and who demonstrate better value receive larger payments? How much larger? What about physicians who do not improve value or efficiency? How should they be measured and how much less should they be reimbursed? How should Congress finance a repeal of the SGR, which the Congressional Budget Office estimates could cost could cost $175 billion over 10 years.
Gail Wilensky, senior fellow, Project HOPE, discussed her recent paper on developing a viable alternative to the SGR.
David Share, senior vice president, Blue Cross Blue Shield of Michigan, described his health plan’s incentive program for physicians that bases payments on value.
Mark McClellan, senior fellow and director of the Health Care Innovation and Value Initiative, Brookings Institution, assessed various payment models for physicians.
Ed Howard of the Alliance and Stuart Guterman of Commonwealth moderated the discussion.
Contact: Marilyn Serafini (202)789-2300 firstname.lastname@example.org
Follow the briefing on Twitter: #SGRfix
Full Transcript (Adobe Acrobat PDF)