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34 EW NEWS & OPINION September 2012 Fly-In focus: The ("un")-Sustainable Growth Rate (SGR) formula by Kenneth J. Rosenthal, M.D., ASCRS Government Relations Committee member W ith the nomination of Rep. Paul Ryan as Gov. Mitt Romney's running mate, it is virtually impossible these days to open a newspaper or turn on the TV without hearing about Medicare and the proposed strategies for "saving" it. Regardless of whose philosophy you subscribe to, there is one thing that just about every physician (and every member of Congress) agrees on: We need a permanent fix to the budgetary crisis surrounding the Medicare program that is cognizant of the real-world cost of running a medical practice, so that we, as physicians, can continue to work effectively and continue to provide quality care to our patients. One of the growing challenges in this regard is the mounting debt caused by the retention of the cur- rently enacted Sustainable Growth Rate (SGR), and equally, in the fact that Congress has annually passed bills that provide a "kick the can Independent continued from page 33 of Health and Human Services (HHS) does in regard to this section. 8. The Secretary of HHS has all the same powers as the board. 9. The board can only be discontin- ued by Congress with a 60% vote in both houses and with the approval of the President (unless they repeal it altogether). 10."The Board may secure directly from any department or agency of the United States information necessary to enable it to carry out this section." (This includes eval- uating all things affecting private sector medical care.) 11.The members of the board are to have no other job, and no more than half of the members can have been providers or managers in healthcare. The creation of this board as described in the Social Security Act embodies the heart of the ACA. The Secretary of HHS and appointed bureaucrats are given wide-ranging powers that are not under the oversight of either Congress or the judicial system. They will have the power to set criminal and civil fines and penalties. Practicing physicians or others actively engaged in health- care are prohibited from decision- making. Hospitals, which make up a large portion of Medicare spending while contributing to the cost estimates, will not be shouldering any of the payment reductions until 2020. Many of the congressional speakers at the Fly-In indicated that they supported repealing IPAB. In fact, legislation to repeal the IPAB, H.R. 5, which also included medical liability reform, passed the House of Representatives in March of this year as a result of a concerted grassroots effort by all physicians. Unfortu- nately, the Senate version of the legislation has stalled. Therefore, as participants of the Fly-In, we indicated our opposition to IPAB and urged Congress to sup- port its repeal. We made the argu- ment that IPAB subjects physicians to double jeopardy through multiple annual spending targets. Since repeal already passed the House of Representatives, we asked our repre- sentatives to cosponsor legislation to repeal the IPAB when reintroduced next year in the new Congress and urged the Senate to pass their version of repeal. It won't be long before Congress recesses for the elections. After the elections, they will return once more before the end of the year for a "lame duck" session. Unfortunately, it is highly unlikely that this issue will be resolved prior to their adjournment, so we need to continue to keep fighting for repeal. We also need to educate our Medicare patients to the danger of IPAB and its impact on their future access to quality specialty care. EW Editors' note: Dr. Price practices at Price Vision Group, Indianapolis. Contact information Price: fprice@pricevisiongroup.net down the road" temporary fix to avoid up to a 30% cut in reimburse- ment. Because the SGR formula is cumulative, the result is an SGR deficit (ongoing and into the future) of over $300 billion. In conjunction with the ASCRS Government Relations Committee and the Alliance of Specialty Medi- cine, I recently attended the Legisla- tive Fly-In in Washington, D.C., to discuss these issues with our elected representatives in Congress. I was very pleased at the responsiveness of the senatorial and congressional rep- resentatives with whom we visited, both in terms of their knowledge of the issues as well as their willingness to be open to our concerns. While my own members of Congress had already formulated their views on this matter, they were open to a nuanced discussion of the issues. One condition that pretty much everyone in Congress agrees upon is that the solution be "budget neu- tral." One of the proposed solutions to paying for a repeal of the SGR involves a reallocation of the Overseas Contingency Operations (OCO), which are discretionary funds for the wars in Afghanistan and Iraq and similar activities. Fund- ing levels for OCO are established each year in the Department of Defense Appropriations Bill, but the Congressional Budget Office (CBO) assumes this expenditure in their projections for the next 10 years. OCO provides a unique and time- limited opportunity to resolve a problem that has been a burden to patients, physicians, and to Con- gress. Passing up this opportunity means that Congress will have an even more costly problem to resolve in future years, requiring even more difficult choices. We also discussed the proposed Medicare Patient Empowerment Act (S. 1042/H.R. 1700), a bill that I am personally very excited about that would establish a Medicare payment option for patients and physicians to contract on a case-by-case basis without penalty for Medicare serv- ices, while allowing patients to use their Medicare benefits and allowing physicians to bill the patient for all amounts not covered by Medicare, and without the current onerous 2- year opt out. This would allow some shifting of costs to the private sector, effectively allowing Congress to bal- ance the Medicare budget without physicians having to be forced to accept artificial fee limitations, which do not reflect either value of services provided nor operational practice costs. Many of the senators and congressmen (including those who spoke with us at the Alliance meeting) were not aware of this bill and were impressed by the fairness and practicality of this prospective measure. For perhaps the first time in years, there appears to be serious and unanimous intent to perma- nently fix the SGR. Therefore, dur- ing the Fly-In, we urged Congress to enact an SGR replacement that updates Medicare reimbursements on the actual cost of providing care; ensures adequate reimbursement for all physicians to avert shortages among specialists and primary care; maintains a fee-for-service option; and provides an appropriate timetable and required investment for additional reforms. EW Editors' note: Dr. Rosenthal practices at Rosenthal Eye & Facial Plastic Surgery, Great Neck, N.Y. Contact information Rosenthal: kr@eyesurgery.org