Beyond the SGR: Alternative Models

January 24, 2014

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

Follow the briefing on Twitter: #SGRfix

The event was sponsored by the nonpartisan Alliance for Health Reform and The Commonwealth Fund.


Full Transcript (Adobe Acrobat PDF)

Speaker Presentations

Stuart Guterman Presentation (Adobe Acrobat PDF)
Gail Wilensky Presentation (Adobe Acrobat PDF)
David Share Presentation (Adobe Acrobat PDF)
Mark McClellan Presentation (Adobe Acrobat PDF)

Event Details

Agenda (Adobe Acrobat PDF)
Speaker Biographies (Adobe Acrobat PDF)

Event Resources