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Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

Finance Holds Third SGR Roundtable with Physician-Focus

July 13, 2012—The Senate Finance Committee July 11 held its third roundtable discussion focused on replacing the Medicare sustainable growth rate (SGR) formula with a new model(s) that moves away from traditional fee-for-service. The committee hosted several witnesses from the physician community to hear their feedback regarding what would work best for doctors and patients, with two AAMC members testifying: Frank Opelka, M.D., FACS, vice chancellor of clinical affairs and professor of surgery, Louisiana State University (LSU) Health Science Center; and W. Douglas Weaver, M.D., MACC, vice president and system medical director of heart and vascular services, Henry Ford Health System.

Finance Committee Chair Max Baucus (D-Mont.) opened the discussion, saying, “Physicians are involved in up to 80 percent of total health care spending” and the committee is looking to “physicians to suggest changes to the Medicare physician payment system that will spur high quality, high value care.” Ranking Member Orrin Hatch (R-Utah) turned his attention to the witnesses, saying, “You have the most direct experience with our current Medicare payment system. As we look for fiscally responsible ways to move beyond the flawed SGR payment system, I urge the physician community to help us find a better path.”

The physician participants agreed that reforms to the system should be based upon existing pilot projects that are being tested around the country in both primary care and specialties, from patient-centered medical homes to accountable care organizations (ACOs). Participants also continued to stress the need for Medicare to update their data system to one that works in “real-time.”

Sen. Maria Cantwell (D-Wash.) asked the physicians, “What do we need to do with graduate medical education,” and “do we have the workforce to implement the strategy we are talking about?” Ardis Dee Hoven, M.D., president-elect, American Medical Association, answered that Congress needs to increase graduated medical education slots and make sure that primary care doctors are taught and rendered in non-traditional venues for residency training. She added that graduate medical education (GME) is “one of the imperatives of this whole discussion.”

When asked by Sen. Jon Kyl (R-Ariz.) if physicians would be ready to present a “methodology for payment” to institute Jan. 1, 2013, or if not, “what should [Congress] do?” Dr. Hoven, said, “Stabilization for practices is a huge and key issue,” and she stressed new systems will “be multiple in type, not a one-size-fits-all” approach. When referring to payment in the interim, Dr. Opelka added, “We’re going to need a bridge.” He noted that they could use help from the Center for Medicare and Medicaid Innovation (CMMI) with data to get an accurate scoring of their model. All of the physicians agreed that January will be too soon to roll out a new payment system, and Congress would need to institute a freeze or payment update until the pilot programs were ready for full implementation.

In the first two roundtable discussions, the committee heard from former Centers for Medicare and Medicaid Services (CMS) administrators and private insurance payers [see Washington Highlights, June 15; May 25]. Without action from Congress, physicians face a cut to Medicare reimbursement of over 27 percent in January 2013.

Contact:

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org