MedPAC calls for SGR replacement with updates opposed by urologists

Saying the sustainable growth rate system is fundamentally flawed and has helped erode the confidence of Medicare beneficiaries and physicians alike, the Medicare Payment Advisory Commission is again asking Congress to repeal the SGR and replace it with specified updates no longer based on an expenditure-control formula, as recommended by MedPAC last year.

“While the SGR may have resulted in lower updates for Medicare’s physician payments, it has failed to restrain volume growth,” MedPAC Chairman Glenn Hackbarth wrote in the foreword to the March 2012 Report to the Congress: Medicare Payment Policy. “In addition, temporary, stop-gap ‘fixes’ to override the SGR are undermining the credibility of Medicare by engendering uncertainty and frustration among providers, which may be causing anxiety among beneficiaries.”

Repeal of the SGR and its replacement with a formula that pays physicians fairly was a priority when AUA and American Association of Clinical Urologists members met at a Joint Advocacy Conference in Washington in March, following passage of the most recent stop-gap fix to delay a 27% cut in Medicare payments for 10 months.

However, MedPAC’s proposed replacement for the SGR is also opposed by urologists and other specialists because the MedPAC recommendation would reduce Medicare reimbursements to specialists by 5.9% per year for 3 years, followed by a rate freeze for 7 years. The reimbursement rate for primary care physicians would be frozen for the 10-year period.

“AACU appreciates MedPAC’s determination to repeal the SGR, but we feel the proposal that came out of your recent meeting falls short of attaining this goal, and has the potential to put at risk Medicare patients’ access to quality urological care,” wrote AACU President Arthur Tarantino, MD, in a letter to Hackbarth after MedPAC formalized its recommendation in September 2011.

MedPAC concedes that under its approach, the resulting Medicare rates would favor primary care, but notes that it also recommends that specialists be allowed to mitigate this effect by providing services through accountable care organizations.

MedPAC is charged with providing independent, non-partisan policy and technical advice to Congress on issues affecting the Medicare program. Urologists and other specialists may refocus their energies on opposing its recommendations now that it appears another advisory bogeyman-the Independent Payment Advisory Board-could be swept away in the Supreme Court challenge to the Affordable Care Act.

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