Wednesday, October 21, 2009

From Senator Tom Coburn Re: Medicare Reimbusement Fix for 10 Years

Preface: This note appeared in, asking the 110,000 Sermo physicians to vote and express their concern about S.1776. which announces S.1776, repeals, SGR, and and fixes doctor Medicare reimbursement

Dear Sermo Physician,

I need your input on an issue being debated in Washington, DC this week: Medicare reimbursements to physicians. Late last week, the Senate leadership announced the Senate is likely to consider S. 1776, which repeals the sustainable growth rate (SGR) mechanism under Medicare.

As you may know, the SGR was created in 1997 with the idea of keeping costs under control. While cost-containment is a good goal, if the mechanism had functioned as designed, physicians would have seen Medicare reimbursement cuts in recent years. In fact, every year since 2004, it has literally required an Act of Congress to prevent Medicare reimbursement cuts under this mechanism. This will happen again this year, or else physicians will see a 21% cut at the end of this year.

There is broad bipartisan recognition that physicians cannot, must not, and will not see a 21% Medicare reimbursement cut at the end of the year. There is also bipartisan agreement that SGR is broken and needs to be repealed and replaced, so Congress need not provide patches each year. There are many, many varying ideas on what a "fix" should look like, and what should replace it.

The AMA and other medical groups are lobbying for S. 1776 as a fix to the SGR problem. I want to provide each of you a chance to speak for yourselves. Here are a few key facts to help you understand S. 1776:

This bill is separate from other proposed healthcare reform legislation in the Senate and the House.

This bill repeals, but does not replace the SGR. Instead, this bill freezes physician Medicare reimbursement rates with a 0% increase over the next decade. There is no guarantee of anything further and it does not address what happens after the ten years are up.

This bill adds over a quarter trillion dollars to the deficit with no offset. This bill is not paid for. To put this in perspective, this price tag amounts to over $5,600 dollars for every senior on Medicare right now. It is larger than all the government funding bills the Senate has considered this year - put together.
This bill does not include any medical liability reform. One of the top concerns the Sermo community expressed to me in past weeks was the need for tort reform/med-mal reform.

As a physician, I firmly believe we deserve better than a one-sided "repeal" of the SGR, which is not "replaced" with something sustainable - and which also does not include tort reform. As a Senator, I am concerned about the fiscal responsibility of adding $250 billion to the deficit. The national debt is already at $11.8 trillion dollars, or over $38,000 per American, and I believe deficit spending and debt effectively steals from our children and grandchildren. Instead, we should be eliminating the estimated $300 billion of waste, fraud, and abuse each year in the federal government.

I want to know what you think is best for you as a physician. Please share with me your thoughts in the accompanying survey and comments below. I will take your input and use it in my conversations with my Senate colleagues. Thanks for your engagement on this issue.

Tom Coburn, M.D.

U.S. Senator, Oklahoma


Michael Kirsch, M.D. said...

I agree with Coburn and I am also a physician. Sure, I'd like the SGR absurdity taken care of. However, I'm not willing to have $250 billion dumped into the deficit for other folks to pay back. Of course, we could capture back tens of billions of dollars if we had some real tort reform. Won't see it during the Obama reign. See

Richard L. Reece, MD said...

On tort reform, Democrats don't the stomach, or Republicans don't have the muscle. We'll have to wait for a political regime change.