Expert: Congress Won't Repeal SGR Formula

When it comes enforcing or repealing the SGR formula, the legal fix that was designed to reduce Medicare growth way back in 1998, don't look for decisive action from Congress any time soon. So says Henry Aaron of the Brookings Institute* in this week's NEJM. 

Congressional enforcement of the SGR formula is untenable because it means making increasingly draconian cuts in physician reimbursement (~21% this year). But the abomination (as Aaron calls it) won't be repealed because the Congressional Budget Office will view the act as an increase in spending. So for now, Congress repeatedly suspends the formula, while keeping the law "on the books" to avoid a monstrous increase in the already monstrous deficit.

However, Aaron offers hope—albeit faint hope. The Patient Protection and Affordable Care Act (aka ObamaCare) offers several provisions that allow for the study of pilot programs (eg, accountable-care organizations) that may [yeesh—tugging at neckline] streamline healthcare and cut costs. Physicians could someday be sufficiently motivated to participate in one or more of these programs, Aaron argues, if the alternative is sustaining a very-deep SGR-defined gash in Medicare reimbursement. Aaron evokes the near-future image of Congress as Vito Corleone ("make physicians offers they can't refuse), but I've got a more vivid picture: Luca Brasi and the Johnny Fontane contract.

SGR = sustainable growth formula.

* Not Henry Aaron of the MLB.

Photo of weathered can from magannie at Flickr.