So here’s a Sustainable Growth Rate (SGR) 101 so you will understand why I am so upset. Section 1848 of the Social Security Act requires the Secretary to make available to the Medicare Payment Advisory Commission (MedPAC) and the public by March 1 of each year, an estimated SGR and estimated conversion factor applicable to Medicare payments for physicians’ services for the following year and the data underlying these estimates.
The SGR is a method currently used by the Centers for Medicare & Medicaid Services (CMS) in the United States to control spending by Medicare on physician services. Generally, this is a method to ensure that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP.
The problem is, the SGR (or the “doc fix,” as it is known) doesn’t work. It is a temporary “fix” that spends more of our tax dollars and endangers access to physician care. This needs a permanent fix. But as with everything in Washington (Blue or Red) every single thing gets earmarks attached and you can’t vote on just one little thing by itself, so this is drowning in the middle of earmarks, making it even more complicated.
So, while there is just a two-month hold on the looming 27% cut on physician Medicare payment, let me shock you: You think LTC docs make a lot? Let’s break this one down.
A physician works in a rural area. We’ll call our generic doctor Dr. X. So Dr. X gets a call that there is a change of condition in his/her resident in your rural facility. It takes Dr. X 45 minutes to drive out to the facility (not compensated). Dr. X then does a comprehensive level 1 visit (the most comprehensive visit that can be performed and billed for). Dr. X speaks to you, then calls the family, then documents in the medical record (not compensated), and then drives 45 minutes back to the office.
Now, kids, guess what the national average reimbursement by Medicare is for that visit … $56. Yup, a whole fifty-six bucks for a minimum of two-and-a-half hours.
Now, decrease that by 27% — OK, I’ll do the math for you: It’s just $40.88 — and tell me you will be able to get doctors to come into your facility for that amount. Because Dr. X has to pay so much for liability insurance (because patients in LTC settings are considered “high-risk patients”), Dr. X will go broke.
And, hey, don’t forget the 10th scope of work and the focus on transitions of care and our national goal to care for residents with acute changes of care at the facility and not send them to the hospital.
So, we the people can do something. You can email congress and let them know how this affects you personally. The American Medical Association (a physicians group) has a great message locked and loaded and ready to go.
Tell Congress to repeal Medicare’s flawed SGR formula.
Just keeping it real!
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC — a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet.