Will the One-Year SGR Patch Enable HITECH?

I found the passage by the U.S. Senate (Dec. 7) and U.S. House of Representatives (Dec. 9) of a one-year “SGR patch” or “SGR aversion” (as some are calling it) fascinating. In brief, members of both houses of the U.S. Congress decided to kick the proverbial can down the road for one more year, forestalling 25-percent-plus cuts in physician reimbursement under Medicare’s sustainable growth rate (SGR) formula at least until 2012.

Interestingly, this legislative action received virtually no attention from the mainstream media—probably because the mainstream reporters on Capitol Hill absolutely have their hands full covering the current Bush tax cuts extension compromise issue, as well as questions surrounding whether the Dream Act and the repeal of the Don’t-Ask-Don’t-Tell military service rule might also be acted on in the week before Congress recesses and the current Congress ends conclusively.

Still, the passage by both houses of Congress of a one-year SGR patch shows that politicians on Capitol Hill can act decisively, and even in a bipartisan fashion, when the conditions are right. Of course, this SGR has now been kicked down the road exactly one more year, and when the issue comes up the next time, it will be in the context of a presidential-year election. Who can say what will happen at that time??? At least, faced with imminent crisis around physician participation in Medicare, members of Congress acted to temporarily forestall potentially disastrous immediate consequences for the Medicare program—and for patients.

In any case, leaders of the American Medical Association have made it clear they want a long-term fix, one that presumably could cost many, many billions of dollars (hundreds of billions, even, in the very long run). Thus, Cecil B. Wilson, M.D., the AMA’s president, issued a statement after the patch was passed, saying that “Many physicians made clear that this year’s roller coaster ride, caused by five delays of this year’s cut, forced them to make difficult practice changes like limiting the number of Medicare patients they could treat. This one-year delay comes right as the oldest baby boomers reach age 65, adding urgency to the need for a long-term solution before this demographic tsunami swamps the Medicare program.” In other words, the snowball will continue rolling down the hill and picking up more snow along the way, leading inevitably to even more challenging decisions to be made in one year’s time.

All that having been said, the passage of the SGR patch should provide at least one very clear benefit, and that is in relieving physicians of what was looking like a terrible conundrum around pursuing meaningful use under the HITECH Act. Yes, on the one hand, individual physicians are eligible for up to $44,000 in HITECH funding if they can achieve meaningful use. On the other hand, 25-percent-plus reimbursement cut could obliterate the potential HITECH funding windfall for many physicians, and, let’s face it, a lot of private-practice doctors weren’t all that eager to automate to begin with, if they had to use their own funds.

So at the very least, the passage of the one-year SGR patch will avert what would otherwise have been a very strong likelihood that quite large numbers of physicians might have bailed out of participating in HITECH, with very major implications for federal policymakers’ goals of health care system-wide automation. As I had reported while at the MGMA annual conference two months ago in New Orleans, the prospect of a clash of federal policy objectives was clearly in the air, with Dr. William Jessee, MGMA’s president, confronting Dr. David Blumenthal of ONC on the challenges facing doctors nationwide should the Medicare cuts become effective at the end of this year. Now, at least, physicians’ overall participation in HITECH is not immediately imperiled, for the moment. Onto the next policy crisis, as most surely, in a society with regularly clashing policy objectives and impulses, there will inevitably be another one soon.