December 2010

Close, but no SGR fix

Or . . . say the secret word or the lame duck will come down and take away 23%*

By Michael J. Katin, MD

Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly, and applying the wrong remedies.
-- Julius "Groucho" Marx

Quote me as saying I was mis-quoted.
-- Julius "Groucho" Marx

Toward the end of November, those of us in the field of radiation oncology joined with our medical colleagues in anticipation -- not of the next breakthrough in particle beam application, not of the next great taxane or gene modifier -- but of whether we would be able to keep our offices open. Once again, the deadline was approaching for implementation of cuts in reimbursement to fulfill the requirements of the Sustainable Growth Rate provision.

1997 was a fairly tragic year, marked by the passing of Princess Diana , Mother Teresa, Jimmy Stewart , George Fenneman, Allen Ginsberg , and Red Skelton, the suicides of 39 Heaven's Gate believers, and the murders of Gianni Versace and The Notorious B.I.G. Bill Clinton began his second term as President. On August 5, the Real Don Steele died of lung cancer, and President Clinton signed the Balanced Budget Act of 1997. This was intended to fortify the intentions of the Gramm -Rudman-Hollings Balanced Budget and Emergency Deficit Control Act of 1985 and the Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987, which were increasingly desperately named attempts to avoid the record deficits rung up by the government in the 1970's and early 80's. Included in the Balanced Budget Act of 1997 was a provision to amend section 1848 of the Social Security Act, to limit Medicare expenditures. The formula provided that if payments for physicians' services exceeded expectations based on the increase in the Gross Domestic Product, then physicians' payments would be reduced to offset the increase. There was no consideration, of course, for the aging of the population, increased access to medical care, and greater sophistication of diagnostic and therapeutic options, but only to the GDP. This system worked very well for all of three years, and by 2002 expenditures were higher than projections and payment cuts were to be initiated. It became increasingly obvious that this decision was similar to reducing policemen's salaries if the amount of crime should increase. In addition, what would happen if the GDP levels off or decreases ? In case of recession or depression, health problems would be expected to increase rather than decrease, with massive cancellations of fitness club memberships and switching to fast foods from Whole Foods . There was enough impact from the objections of Medicare recipients that Congress began the first of many stays of execution of implementation of the SGR principle, but never going back and undoing the cause of the problem. As a result of this, cumulative decreases in physician reimbursements had reached 23% as of the end of this year. Interestingly, as a result of all the deficit reduction efforts, the deficit is now higher than ever, just as illiteracy is higher than ever since the initiation of the Department of Education and just as we are more dependent than ever on foreign oil since the creation of the Department of Energy.

By the beginning of November, the threatened reimbursement cuts still loomed. The economy was stimulated somewhat as medical practices purchased thousands of pink slips and commissioned signs stating either "Closed," "For Sale," or "Will Treat for Food." At the very last minute, the lame duck House of Representatives passed the Physician Payment and Therapy Relief Act of 2010, following the Senate's passage earlier in November, which definitively solves the problem of SGR-mandated physician reimbursement cuts once and for all . . . until December 31.

The way this is being handled, the SGR threat is sort of like death, since we know it's coming but we don't know when, and we do our best one day at a time as if it's never going to happen. We just need to live our life like a candle in the wind. Unfortunately, it might be an ill wind.

* The secret word is "single-payer"