Need for 18-Month SGR Fix Takes Center Stage — Urge Congress to Act

Ronald Szabat, J.D., LL.M.
Executive Vice President – External Affairs and General Counsel


ith each passing week, all physicians come closer to massive Medicare cuts, set for July 1, 2008, unless Congress acts soon. For anesthesiologists, this would be a bitter pill, following recent highly successful efforts by ASA that closed by half the Medicare payment disparity between our own anesthesia conversion factor and other physician payment services.

Unlike the deliberate short-funding of a Medicare update short-term fix for 2007 by former House Ways and Means Chairman Bill Thomas (R-CA), whose tastes ran more to giving billions in tax breaks to Indian gaming casinos rather than sustaining Medicare, the situation is now different. Try as hard as he did, current Senate Finance Chairman Max Baucus (D-MT) was effectively blocked late last year by Senate rules, deftly used by some Republicans and a wholly unsympathetic Administration, as he sought two years of positive updates in Medicare physician payments. The result for the second half of 2008: an added cut of 5 percent that still needs to be financed over four more years thanks to Bill Thomas’ 2006 late-session shenanigans, and now the need to sustain funding for the current 0.5-percent positive update for the rest of 2008 and beyond.

Doing the simple math, this means that to avert a 10.6-percent cut in July and a 15-percent cut from the current baseline in 2009, tens of billions of dollars must be found to avert Medicare physician payment cuts now and into the future. And make no mistake about it, House Democrats, notably the chairs of the powerful House Ways and Means and Energy and Commerce committees and their respective subcommittees, also have tried mightily to avert this crisis, but then, as now, their progressive and helpful approaches to help physicians and Medicare seniors are still wanting broader Senate support and the embrace of previously sympathetic House Republicans.

So what is the game plan? ASA, working together with a strong coalition of like-minded state medical and national medical specialty societies, is actively pursuing possible legislation — aimed first at helping to build support for Chairman Baucus and ranking member Charles Grassley (R-IA) — on the Senate Finance Committee and beyond. Simple in its approach but straight to the point, organized medicine is united in seeking the continued positive Medicare update for 2008 and then moving to a full update, if possible, tied to the Medicare Economic Index for 2009 of an additional 1.8 percent.

It is imperative that any Medicare "reconciliation" legislation cover this 18-month period to provide stability in Medicare financing and avoid both short-term cuts in July and longer-term cuts in January 2009, especially because Congress is set to adjourn early in October as final campaigning starts for the November presidential and congressional elections. Making this happen, of course, is going to take concerted direct and grassroots lobbying.

As legislation moves forward, ASA members are implored to watch our Web site — under “What’s New” on the front page — for timely alerts and calls to action. Only by making our voices heard, once again on Capitol Hill, can the promise of our recent 32-percent Medicare work value increase be sustained. All ASA members are urged to act and help keep up appropriate pressure on our federal legislators.