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Medicare Sustained Growth Payment Model Questioned


The healthcare reform act intends to extend insurance coverage for millions of Medicare patients nationwide, but that doesn't mean it will expand their access to physicians.

The healthcare reform act intends to extend insurance coverage for millions of Medicare patients nationwide, but that doesn’t mean it will expand their access to physicians. Languishing payment models of the federal assistance program, in addition to the subsidies expected to be given to consumers in the healthcare insurance marketplace, have caused care providers concern.

A recent US Department of Health and Human Services report found that in 2013, 735,041 physicians saw new Medicare patients compared with the 705,568 they saw in 2012. Such significant growth in this number has not been seen since 2005. Some advocates suggest these numbers demonstrate that the access of the elderly to healthcare is not affected by Medicare insurance policies.

“Overall, the clients we deal with have good access to physicians,” said Joe Baker, president of the Medicare Rights Center, a non-profit advocacy group for older Americans and people with disabilities. “We find the physicians who don’t take Medicare don’t take other insurance, either, but it's not a problem we see regularly.”

But the report findings do not seem to have settled physician concerns. Mr Baker adds that the delayed “sustained growth” payment system could cut Medicare rates by 30%. This has led many doctors to voice concerns about how they will be reimbursed, or what has been colloquially named the “doc fix.”

The American Medical Association (AMA) president, Dr Ardis Hoven, said the report does not appropriately address all the issues of Medicare.

“There are more than 49 million patients enrolled in Medicare and an average of 10,000 baby-boomers aging in each day and MedPAC’s report shows that one in four Medicare patients seeking a new primary care physician had trouble finding one,” Dr Hoven said in a recent article. “While Medicare physician payment rates have remained flat since 2001, practice costs have increased by more than 20 percent due to inflation, leaving physicians with a huge gap between what Medicare pays and what it costs to care for seniors. The SGR continues to schedule massive cuts.”

Dr Hoven also noted that the current Medicare system is not sustainable as is. “Fortunately Congress is working on that earlier this year than ever before to repeal the SGR and move to new models of care that allow doctors to focus on coordination and quality while reducing costs,” Dr Hoven said.

In fact, the US House Energy and Commerce Committee unanimously approved a Medicare physician payment bill on July 31 that would abolish the SGR formula and would provide a 0.5% physician payment increase for the next 5 years. However, the committee first must find a way to offset the costs of the repealed bill before it goes for full House approval.

Brandon Glenn reported in Medical Economics: “It’s easy to reach consensus that the SGR formula is flawed and needs to be replaced, but Congressional leaders are likely to soon find out that coming to agreement on what it needs to be replaced with is a whole other ballgame.”

Around the Web

Report: More Doctors Accepting Medicare Patients [USA Today]

House Committee Passes SGR Repeal Bill Before August Recess [AAFP]

US Says More Doctors Accept Medicare Patients, Access 'Excellent' [Forbes]

The SGR Repeal Bill Increases Physician Payment by 0.5% Annually. Is That a Fair Amount? [Medical Economics]

The SGR repeal bill increases physician payment by 0.5% annually. Is that a fair amount? - See more at: http://medicaleconomics.modernmedicine.com/node/371920#sthash.aiJ1EglT.dpuf

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