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Welcome to Congressman Larry Bucshon

Representing the 8th District of Indiana

Dr. Bucshon's Statement on SGR Repeal

March 14, 2014
Press Release

On Friday, the House passed H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, a bill that repeals the current sustainable growth rate (SGR) formula and replaces it with a permanent solution to address physician payments in the Medicare program and protect seniors’ access to health care.

Bucshon, a physician from Southern Indiana, released the following statement regarding the passage of H.R. 4015:

“The President has delayed the ACA over 21 times. This includes a recently announced back door delay of the individual mandate to purchase health insurance due to the ongoing failure of the law to provide affordable coverage options for the American people. Today, the House passed a permanent repeal of the flawed Medicare SGR physician payment formula, paying for the change with a similar approach, a five year delay in the individual mandate to purchase insurance through the ACA.

“As a practicing physician for over 15 years, the majority of my patients depended on Medicare. I know firsthand how flawed the SGR formula is. It’s very difficult to operate a business, such as a medical practice, when Washington politicians continue to play politics with Medicare. By not repealing this flawed system, many doctors across America will be forced to limit the number of Medicare patients they serve and many will be forced to turn away Medicare patients altogether. Failing to act will undoubtedly limit seniors’ access to their doctors.  This will be especially dangerous in rural areas where there are already physician shortages, like many communities across Indiana.

“President Obama and Senate Democrats should immediately act on the House passed legislation to protect access to medical care for America's seniors. We agree that the individual mandate needs delayed. Let's work together to finally solve this problem and take away the uncertainty that has been plaguing Medicare for over a decade. America's seniors and physicians deserve action.”

LEADING THE CHARGE:

Before serving in Congress, Bucshon served as President of Ohio Valley HeartCare and Chief of Cardiothoracic Surgery at St. Mary’s Hospital in Evansville, Indiana.  During that time, Bucshon served Medicare patients and experienced first-hand the uncertainty caused by the status quo of physician reimbursement through the program.

In Congress, he is a member of the GOP Doctors Caucus, a group of 21 medical providers who utilize their medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice. With their unique background serving Medicare patients, the group played an integral role helping the Energy and Commerce and Ways and Means Committees develop a solution to this ongoing challenge.

In late February, they sent a letter to Congressional leaders urging immediate action on repealing SGR and replacing it with a fiscally stable, permanent solution.

While the legislative framework was being drafted, Bucshon’s comments were included as support for the work being done in the Energy and Commerce and Ways and Means Committees to help build momentum in Congress.

He also released statements when the initial framework and subsequent update were released applauding the reforms as “vital to ensuring seniors have access to predictable, quality care and that physicians are afforded necessary certainty.”

Early on Friday, Bucshon took to the House floor to urge his colleagues stand up for seniors by supporting H.R. 4015.

BACKGROUND:

The sustainable growth rate is a formula that was enacted in 1997 to control physician spending under Medicare.  However, the SGR policy flaws have compelled Congress to override the formula driven cuts for more than a decade.  In fact, since 2003, Congress has passed short-term patches, known as a “doc fix,” 17 times creating ongoing uncertainty and costing nearly $150 billion.  On March 31, 2014, the most recent three month patch included in the Bipartisan Budget Act will expire. As a result, physicians will see an approximately 24 percent cut in reimbursement rates if left unaddressed.  

According to the American Medical Association (AMA):

  • One in five physicians overall are currently restricting the number of Medicare patients in their practice

  • One-third of primary care physicians currently restrict the number of Medicare patients in their practice.

  • Two-thirds of physicians considered opting out of Medicare and treating patients through the private contracting option due to reimbursement cuts

  • To adjust for reimbursement reductions, physicians also considered:

  • Delaying payments for supplies, rent and/or other expenses

  • Taking out a loan or line of credit in order to continue paying bills

  • Holding up paychecks or laying off/furloughing staff

  • Cancelling or postponing scheduled services to Medicare patients

  • Temporarily closing practice to new appointments with Medicare patients

These trends are in part due to the flawed Medicare reimbursement structure and failing to pass a solution will only exacerbate the problem.

What does this mean for Indiana[1]?  

Seniors in Indiana are already facing physician access challenges, which will only increase without the necessary reforms to Medicare payments. Currently, Indiana has 13 practicing physicians per 1,000 Medicare beneficiaries, which is well below the national average.

Reforming the broken, flawed payment system would help prevent a loss of $270 million for care of elderly and disabled patients in Indiana for the remained of 2014.

These cuts will make it difficult for physicians to stay in business, which will further limit access to care for everyone and put jobs at risk.

In Indiana alone, “the jobs of 70,851 employees of medical practices, as well as access to care for 1,048,499 Medicare patients and 90,200 Tricare patients are at risk due to these cuts,” according to the AMA.

The Wall Street Journal echoed this concern, “The number of doctors who opted out of Medicare last year, while a small proportion of the nation's health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don't formally opt out of the system.” (WSJ; 7/29/2013)

As of January 2014, the White House had unilaterally delayed the Affordable Care Act 21 times. Here is a list - http://energycommerce.house.gov/blog/6-months-executive-obamacare-delays.



[1] Data, statistics, and information provided by a report published by the American Medical Association in March of 2014. The report can be accessed here - http://www.ama-assn.org/resources/doc/washington/sgr-states-in.pdf.

 

 

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