MedPAC: Toss SGR and Replace with Freeze

The Medicare Payment Advisory Commission’s (MedPAC’s) report to Congress regarding Medicare’s fee-for-service payment system is clear: Replace the sustainable growth rate (SGR) with specified updates not including an expenditure-control formula.

MedPAC said the SGR should be replaced with a 10-year series of statutory fee schedule updates comprised of a freeze for primary care and three-year, 5.9 percent reductions for other specialties, followed by a freeze. The group also asked the secretary of the U.S. Department of Health & Human Services (HHS) to collect data to establish more accurate work and practice expense values. Overpriced fee schedule services should be identified, MedPAC’s report says, and HHS should reduce relative value units (RVUs) accordingly, using the data gathered.

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Under the 10-year update path specified in the report, Congress should direct the secretary to increase the shared savings opportunity for physicians and health professionals who join or lead two-sided risk accountable care organizations (ACOs). The secretary should compute spending benchmarks for these ACOs using 2011 fee schedule rates, MedPAC recommends.

6 Responses to “MedPAC: Toss SGR and Replace with Freeze”

  1. John Harrison says:

    cut cut cut, before you know it we will have no doctors and too many plumbers because the insurance industry will chase all the doctors into bankruptcy or worse. Why would any child want to be a Doctor these days when facing all the overhead, reimbusement cuts and sue happy patients? Plumbers make more money and no one rejects their claims left and right. When O’bama care kicks in it will make the insurance industry even more profit driven and cause even more denials than it already issues. If the government would make insurance companys non-profit, that is the only way to make sure everyone gets quality care at an affordable rate, otherwise it is just the insurance companys making obscene profits and no doctors to treat patients

  2. Zena McConnell says:

    I agree wholeheartedly!! Take a look at the highest paid industry in the world – it is not the medical field by a longshot – it is INSURANCE. And then take a look at the bankrupt bail out rate of insurance companies and you will see who is irresponsible and not regulated.

    And the insurance companies are manipulating the FEDERAL RULES to fit their own profitability, while denying physicians claims for NO REASON (HUMANA) on a regular routine basis with no penalties for delaying payment to physicians and no penalty for the adminstrative overhead they have outlandishly inflated due to unwarranted refusal to pay physicians claims.

  3. Tina Cleveland says:

    Does anyone think it’s time to go back to paying doctor’s and hospital’s directly? If I seriously put into an annuity (yet another insurance company product) the money I pay each month in insurance premiums, I might have enough to pay for some of my care later. Whether I have insurance or not, paying for my portion alone would still bankrupt me in a catastrophic event, or end of life. So many are uninsured, but there are still enough people that believe healthcare is a right and not a luxury that I’m hoping they’ll be benevolent when my turn comes up. I’m sure there is more than one person that feels that “if you can’t beat ’em, join ’em”.

    In spite of my personal views, all this complexity and administrative struggle has been good for me. I own a medical billing company and do my best to help my healthcare provider clients. Even so, more than a handful are giving up and starting to investigate other careers, and that’s too bad.

  4. mambocoder says:

    I think this is good and bad. Put all doc’s on the same playing field- good. Primary care docs need the same pay as specialist because they work just as hard. Decreasing their ability to keep the lights on- bad. when Ins co’s were not publicly traded they were more interested in keeping the providers paid. Now they have to answer to shareholders and the stock market. Make them all non-profit and employee owned, take them off the stock and put their cost ratios back to 90% and then the cuts make sense. we need to stop requiring multiple tests for things our docs know how to treat, and keep training the way our older docs were trained. if you need an MRI, you should get an MRI, not an Xray, then a CT then an MRI. That’s where the costs get eaten up. Go after the lawyers who eat up most of the costs in the suits- some of the insurance company execs too, but mostly lawyers. Cap their fees and make them accountable for the stupid stuff they do. Maybe if those changes happen too, this won’t be as big a disaster as it looks to be. Either way, medicine is forever changed.

  5. Paula Zedlitz says:

    What everyone has said it so true—but the only way we can make a dent in changing this is to VOTE. This election is too important to our way of life. We are the only ones that can change it–one vote at a time.

  6. Dawn says:

    All of the above comments are so correct. Allow me to step a little further into some additional concerns that contribute to the problems. 1. Isn’t it about time for our OVER PAID politicians to have a pay freeze Do the voters have a say every time a pay increase is granted to them? NO, our only say is when we cast our vote for the person we believe will fairly and honestly represent our communities, states and country. 2. And how many of our politicians have their hand in the insurance industry? MANY, MANY, MANY, which should be totally forbidden. 3. Let’s step on the toes of restitution. How long and how many of every working American dollar is going to the rebuilding of other countries (England, Germany, France, etc) for WWI, WWII, Korean Conflict, Viet Nam, and Afghanistan to name a few. The BILLIONS of our hard earned dollars, go to these countries every year from the US of A. Put the money into our health care system and wouldn’t it be possible that EVERY AMERICAN could have health care coverage and not have to take it off their kitchen table or food pantry?

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