Executive office update: The SGR pony

Sunday, January 01, 2012 12:07 PM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

For those of you keeping score, and by now most physicians have probably stopped counting, it’s year nine of the SGR debacle, where Congress takes us to the brink of the apocalypse, then kicks another balloon-financed can down the road. But this year, we may see the beginning of the end of this ritual hazing.

Our most recent pilgrimage to Washington for AMA’s annual national bracing of Congress, a time-honored ritual whereby physicians from across the country convene and systematically go door-to-door to lobby their respective congressional delegations, may be approaching a tipping point. Here’s why.

Bipartisan consensus
We now have a broad, bipartisan consensus – including our congressional delegation – that the SGR in fact never worked, never will, and further cuts will be catastrophic. It is now universally recognized that it is financially irrational and irresponsible to continue to fund patches that have provoked a budget hole that is now $300 billion-deep.

Peace dividend
There is currently an offset funding source that has the consensus support of AMA and all the major specialty organizations, a windfall opportunity created by the drawdown of our military presence in Afghanistan and Iraq. Congress allocates discretionary funds annually, called the Overseas Contingency Operations fund, that we are arguing have been freed up. Call it a peace dividend, or a war-wind-down windfall, regardless, it presents a one and only shot at a clean slate, wiping the books and setting the stage for a substantive retooling of how to truly reform Medicare’s payment policies, volume controls, and cost curve bending efforts.

Evidence-based policy options
Our CMS, along with our AMA and the major medical specialty organizations, have put on the table an array of evidence-based policy options that can bend the cost curve, realign reimbursements around value and performance, support physicians during the transition, and reverse this unsustainable trend. Congress has demonstrable, viable options, many drawn from real world practice. Many members of Congress, certainly most in our congressional delegation, support that notion.

The doctrine of equal risk
It is a tipping-point election year, and neither party collectively wants to risk the political consequences of the disruptions to a large and largely voting senior population. I know, “duh,” but this Congress has the lowest public confidence ratings since Gallup started polling nearly four decades ago. In politics we call it the “doctrine of equal risk.” Neither side gains from the corrosive, partisan finger-pointing and name calling, so the opportunity to fix problems instead of blame rises.
Foundation for serious reform of Medicare policy
We are seeing and hearing a shift toward bipartisan problem solving in the byzantine world of Medicare policy. The always thoughtful and innovative Senator Ron Wyden (D- OR), who headlined the CMS annual meeting a couple of years ago, has teamed up with his political polar opposite Paul Ryan (R-WI) to come up with what the health care policy experts are calling the “foundation for serious Medicare Reform.”

The proposal is an artful balancing of market strategies favored by Republicans with coverage and care continuity concerns pressed by Democrats. It is an outline more than a policy at this point, but it shows leadership on the two most daunting barriers to real reform: political feasibility and controlling costs. More about this later. We have invited Senator Wyden to our 2012 annual meeting for an encore presentation and analysis of their work-in-progress.

Our conversations with the Colorado delegation, both at home in their districts and on the Hill, emphasize what is already a strong disposition toward collaborative, team-based care, a willingness to pilot and test cost-curve-bending ideas, and to stay out of the partisan swamp where good ideas go to get stuck.

Among the many colorful barnyard metaphors about politics, there’s one about optimism when things seem most bleak I heard often in Texas: “With a pile of manure this high, there must be pony at the bottom of it.” While the odor is still strong, I can also hear that pony climbing out.