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Health Policy Update: Medicare Patient Access

By Katie Ni
AMSA Education & Outreach Coordinator, Health Policy Committee

In a near-impossible feat of bipartisan collaboration in Congress, the House Energy and Commerce Committee has voted unanimously, 51-0, for a bill that aims to solve the long-overdue problem of Medicare’s sustainable growth rate.

Since 1997, the sustainable growth rate (SGR) has been employed as a method to control Medicare spending by ensuring that increases in expenses for Medicare recipients do not exceed the yearly increase in GDP. However, the SGR formula achieves this goal by cutting payment for physician services. By this method, physicians have faced proposals for significant cuts every year for the past dozen years, followed by last-minute “doc fixes” from Congress that help undo the cuts. SGR has therefore long been a huge headache to physicians, and serve as a disincentive for physicians to treat Medicare beneficiaries. Continuation of the current SGR system threatens to reduce Medicare recipients’ access to health care services every year, and is also costly for Congress to continuously patch up with “doc fixes”.

The proposed bill, to be called the “Medicare Patient Access and Quality Improvement Act
of 2013”, will repeal the current SGR system and eventually replace it with a system that rewards physicians who perform well on “quality assessments”. The prospect of a permanent solution to the sustainable growth rate is a step in the right direction.

Some physician groups have voiced concerns regarding the bill’s cost reduction methods. The bill reduces payment to services it overvalues by 1% each year from 2016-2018. Historically this money has been placed back into areas that are undervalued. If this policy is removed, it will undermine the scheduled payment increases leaving vulnerable funding “holes”. While the bill provides 5 years of stable Medicare payments, the payments grow 0.5% each year, an increase that fails to keep up with the costs of providing Medicare services.

Despite the unanimous support in the house committee, Senate Finance members announced they are creating their own bipartisan “doc fix”. While it is unclear how quickly this bill and future propositions will get passed into law, the means by which these bills maximize provider participation in the Medicare program and safeguard access to health services for Medicare beneficiaries should be thoroughly addressed.

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