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Posted by on Oct 6, 2010 in Health care, Legislation

Medicare Reimbursement: Looking to Kick the SGR Can Into Oblivion

Medicare Reimbursement: Looking to Kick the SGR Can Into Oblivion


In characteristic fashion, freelance writer Robert Lowes, reporting for Medscape, is all over any novel Medicare legislation. He notes that a new bill, introduced this week by Senate Democrat Blanche Lincoln of Arkansas, would repeal the controversial and much-despised SGR formula, which dictates dramatic cuts in Medicare reimbursement to physicians.

Implementation of the SGR-defined cuts in Medicare payments has been perpetually and repeatedly delayed by Congress, while the legislative body has failed to repeal the formula. (For reasons why, go here.) Congress’s latest kick-the-can measure postpones a 20-something-percent cut in Medicare reimbursement to December 1st.

Blanche’s proposal calls for use of the Medicare Economic Index, or MEI, which correlates reimbursement to escalating physician-practice costs rather than the less-steep general inflation rate. According to Lowes, the Congressional Budget Office has not yet published an estimate of how much Lincoln’s bill will cost, but previous SGR-repealing bills added more than $200 billion to the deficit.

“While it is unlikely that Sen. Lincoln’s bill will come up for a vote before year’s end,” Lowes writes, “her proposal may spark a Congressional debate on a permanent doc fix early next year.” Otherwise Congress is expected to convene a lame-duck session after the November elections to pass critical legislation, which possibly includes another stay to the SGR-defined cut in Medicare payments.

SGR = sustained growth rate.

Photo of weathered can from magannie at Flickr.

bmartin (1127 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.