Star-Telegram - Fixing Medicare's Provider Payments

Op-Ed

By Michael Burgess

At town hall meetings and events across greater Fort Worth, seniors ask me repeatedly why they had to change doctors when they enrolled in Medicare.

Doctors and care providers tell me that they simply cannot afford to continue caring for Medicare patients because they are threatened with reimbursements that fall short of service costs.

Simply put, the Sustainable Growth Rate formula (SGR) is the top culprit.

I've been trying to repeal it since I came to Congress in 2003. As a physician, I know first-hand how destructive this formula is to the doctor-patient relationship.

For background, SGR was approved by Congress in 1997 as an attempt to mitigate the growing cost of Medicare services. But the formula proved uneven to the growth of the medical industry, highly unrealistic and ultimately threatening to care providers' ability to serve patients.

Since 2003, Congress has continued scrapping together "patches" to soften SGR's economic blow for service providers. This method creates never-ending uncertainty for providers and constantly threatens seniors' access to care.

This path is unsustainable.

But there's new hope. After wasting time and taxpayer dollars re-hashing this issue 18 times since 2003, Congress is closer than ever to a permanent solution.

In a rare show of unity, the House of Representatives on March 27 passed "The Medicare Access and CHIP Reauthorization Act," to repeal the Sustainable Growth Rate and preserve the integrity of our Medicare system. The measure received an astounding 392 votes.

This bill is all about access for seniors and the end of the annual threat to their care. Once SGR is repealed, the new system will streamline Medicare's existing web of quality programs into a single framework.

It will drastically improve payment accuracy and encourage physicians to adopt proven practices. It will create a more transparent system where doctors -- not bureaucrats -- are in charge.

Most important, the bill will finally stop the uncertainty of dramatic payment cuts. It enacts a 0.5 percent payment update for five years, bringing stability and longer-term financial certainty.

Additionally, it incentivizes the use of alternative payment models that encourage coordination among providers and preventative services to improve quality and lower cost.

The bill points us back toward fiscal sanity, the first major entitlement reform in nearly 20 years.

The nonpartisan Congressional Budget Office says this legislation will likely result in a net savings, because freezing Medicare's payment rates would cost much more than this fix -- to the tune of about $1 billion.

For Washington, this ends years of irresponsible policies. For the elderly, it means a stronger overall Medicare system. For taxpayers, it means honest accounting, real savings and brings us closer to fiscal solvency.

If the Senate doesn't act on this legislation when it reconvenes April 13, it means another year of instability for seniors and providers. Because the last patch expired on April 1, an automatic 21 percent pay cut for providers was triggered, which must now be fixed.

We're closer than ever to putting this issue behind us, and I am proud to have done my part.

This must be done, and I won't stop working on it for seniors and providers until it is law.

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