Rep. Schwartz urges supercommittee to adopt her Medicare "doc fix"

Rep. Allyson Schwartz (D-Pa.) on Wednesday sent the deficit-cutting supercommittee a detailed proposal to overhaul Medicare's unworkable physician payment system.

The proposal would prevent a scheduled 27.4 percent cut to doctor payments on Jan. 1 and put in place a six-year transition period with fixed payment updates. After that, the Department of Health and Human Services would be tasked with coming up with at least four payment systems physicians could choose from, based on their location, patient mix and other factors.

A flat-out repeal of the SGR is estimated to cost about $300 billion over 10 years. Schwartz said she anticipates that her bill would save money compared to the temporary patches that lawmakers have regularly been adopting for years to prevent the scheduled cuts from going into effect.  

"If (supercommittee members) are serious about dealing with the deficit," she told reporters, "they can't ignore the SGR."

Schwartz said she's talked to both House and Senate Democrats on the supercommittee and got good feedback. She said she'll ask the supercommittee to request a Congressional Budget Office score for her bill after she sends them legislative language.

"None of them said to me, 'don't do it, don't bother'," she said. "They in fact said 'sent it to me'. Most of them feel they should fix it if they could."

The proposal calls for flat payments in 2012 and an annual increase of 0.5 percent for specialists from 2013 through 2016. Generalists would see a 2.5 percent annual bump, in keeping with the healthcare reform law's efforts to attract more medical school graduates into primary care.

The proposal also seeks to wean doctors off the standard Fee For Service system that pays by procedure and get them into new models that will reward coordination and quality. Beginning in 2018, physicians who remain in the current system will be disincentivized through gradual cuts: - 2 percent in 2018, - 3 percent in 2019, - 4 percent in 2020 and - 5 percent in 2021.

Several medical groups praised the proposal, including the American College of Physicians, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

The powerful American Medical Association, however, withheld support because it thinks the proposal isn't generous enough.

"While we applaud Rep. Schwartz's general framework, we cannot support the proposal's outline for future updates and penalties given the workflow changes and investments we expect will be required from physicians," AMA President Peter Carmel said in a statement. "There is also uncertainty about the broad availability and applicability of new payment models across the full range of medical specialties and practice settings."

Schwartz said some physicians, mostly ones who see few Medicare patients or have been in practice a long time, would be exempted from the cuts to traditional Fee For Service Medicare payments.

Update: This post was updated at 5:45 p.m. with comment from the American Medical Association

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