How to solve the SGR gridlock

For 11 years, Congress has failed to reform the Medicare physician payment system, and appears prepared yet again (for the 17th time) to fall back on another one-year patch for the unpopular sustainable growth-rate (SGR) formula to avoid a 24% cut in payments to doctors.  As House minority leader Nancy Pelosi said recently, “Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary provider payment reductions to maintain a corrosive policy that essentially every member of Congress says should be scrapped.”

Every year, physicians have been asked to pony up to support campaign contributions through AMA, state, and specialty society sponsored PACs to encourage Congress to resolve this problem, and every year (for the last 17) Congress has failed to successfully address SGR.  There is no consensus in Congress on how to cover the $140 to $180 billion it would take to repeal SGR, but there is broad, longstanding bipartisan support and consensus for the need to replace this flawed formula and preserve reasonable Medicare payment rates for physician services.  The American Enterprise Institute, the Brookings Institution and the Bipartisan Policy Center have all supported Medicare cost-sharing and supplemental coverage reforms put the Medicare program on sound financial foot and help pay for SGR repeal.  Why, then, has Congress failed to get the job done through so many election cycles?

The likely answer is that there is an incentive for Congress to continue to play out this legislative gridlock as long as possible: to be able to keep sucking on the physician sponsored campaign contribution PAC tit year after year in a strategic exercise of solicitation and finger-pointing to keep these contributions rolling in despite the lack of progress on a legislative solution.  Let me be clear on this point, though: I am very much in favor of physicians contributing to their favorite physician PACs and having these PACs use carefully designated political contributions and lobbying efforts to influence the political process to solve health care’s most pressing problems.

It’s the system we live with, and until there is real campaign finance reform (don’t hold your breath), we are stuck with it.  However, if the definition of insanity is doing the same thing over and over and expecting a different result; the strategy of using PAC money to promote repeal of the SGR is the height of insanity.  In 2013, physicians spent hundreds of millions of dollars in federal election campaign contributions, and twenty times that for lobbying; and repeal of SGR was one of the top issues targeted in the use of these funds.

I got a call recently from a representative of ACEP’s NEMPAC, and the caller requested a donation to help pass a long-term solution to the SGR formula, even though it looks almost certain that another one year “kick the can down the road” result is in the offing.  I committed to a contribution to the PAC; but I would rather the money be used to address problems with the “greatest of three” standard in the PPACA, or ED boarding, or even liability reform, or some other problem where consensus has not already been forged, and there is a minimal chance to actually move the ball.

So how would I fix the doc-fix problem?  I would like to suggest that physician sponsored PACs stop making any political contributions to congressional campaigns until a permanent, acceptable solution to the SGR problem is signed into law.  It seems crazy to me to continually pump money into these campaigns just to keep the 24% reduction in payments ax from falling on the necks of physicians when it is pretty clear that voting seniors would have a conniption fit if Congress were to let this happen, and their access to physician services was jeopardized in this way.

What’s the downside?  Oh, I suppose the trial lawyers might try to take advantage of this lull in physician “advocacy” to promote their agenda; but just think of the war chest that would accumulate in our PACs in the interim, and how this might put the enticement and finger-pointing strategy on the other foot for a change.  Campaign contributions are a pretty powerful narcotic for folks in Congress, and withdrawal symptoms could be very compelling.

Myles Riner is an emergency physician who blogs at The Fickle Finger.

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