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    The Podium

    How to reform the Medicare physician payment system

    For more than a decade, an outdated Medicare cost control called the Sustainable Growth Rate has repeatedly threatened patient access to care with drastic Medicare provider cuts. Physicians face constant instability, demonstrated by the scheduled 23.7 percent SGR-induced cut to provider payments scheduled for April 1.

    Finally, after more than a decade of temporary fixes, SGR repeal appears within reach through the advance of S.2000/H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014. Congress can stabilize the Medicare program and transition to a program based on the quality and value of the care provided rather than the quantity of procedures, services, or tests ordered.

    Congress has spent an estimated $154 billion, which is more than the cost of H.R. 4015/S.2000, on 16 short-term patches in the last decade. These patches are the equivalent of paying the minimum on your credit card bill — it delays the inevitable, increases the total bill and is bad for the budget. Expanding the patches only propagates the current uncoordinated health care system and increases the cumulative debt on the government “credit card.” This bill is much more important than simply paying off what is owed because of the SGR. It provides a more coordinated effort that promotes the delivery of value-based health care.


    Over the last year, a group of congressional leaders have led a bipartisan, bicameral and inclusive process to reach consensus on how to repeal SGR and reform the Medicare physician payment system. They allowed the members of the medical community, including my organization, the American College of Surgeons, to work as partners with them to help resolve this difficult issue.

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    Together, not only have we found a way to repeal SGR, but we have also been able to streamline existing quality programs, encourage alternative payment models, and move towards a value-based system that rewards high quality, efficient health care.

    Moreover, this legislation is supported by the vast majority of national and state medical organizations. Physicians have kept their promise to unite around sound policy reforms that will help build a more sustainable, fair and efficient Medicare physician payment system. And it will help create a learning health care system that continually improves the health outcomes of individuals and populations.

    It is time for our representatives in Washington, D.C., including those from Massachusetts, to keep their promise and support and pass this landmark legislation.

    If it doesn’t pass, there is a real chance that as more Medicare patients in Massachusetts lose access to physicians, emergency departments and trauma centers in Boston and other big cities will become even more overwhelmed with patients than they already are. That will hurt the quality of care for anyone who is in a car crash or has an emergency medical need — which, of course, could be any of us at any time.


    Our representatives must make sure that this legislation stays on track and becomes law. I know that my organization and its more than 79,000 members stand ready to work to help achieve that end.

    We need to stop stalling, stop playing politics with the Medicare program and its beneficiaries. It’s time we repeal SGR and resolve the Medicare payment crisis. Our reward will be a patient-centric, quality-based health care system that’s efficient and affordable. That’s good for everyone, especially patients and taxpayers.

    Andrew L. Warshaw is a professor of surgery at Harvard Medical School and president-elect, of the American College of Surgeons.