CHCE Forum: The SGR Fix: A Pathway to Fundamental Physician Payment Reform?

Despite disagreement over how to pay for a repeal of the sustainable growth rate (SGR) formula, which adjusts Medicare physician fees to limit spending, many lawmakers seek to discard this flawed policy. Their goal is fundamental reform of physician payment, shifting away from traditional fee-for-service reimbursement to other payment models that enhance the quality and efficiency of care. Regardless of how Congress addresses the SGR formula in the 114th Congress—via a permanent policy change or a temporary patch—the 2014 “SGR fix” proposal provides a framework for how payment reform in Medicare could be used to help transform the organization and delivery of health care.

In a new publication released in March, Mathematica senior fellow James Reschovsky unpacks the details of the proposed SGR replacement, including the new Merit-Based Incentive Payment System and several other payment models (such as accountable care organizations and patient-centered medical homes) encouraged in the legislation. Reschovsky and a panel of experts discussed these value-based models in a policy forum hosted by Mathematica's Center on Health Care Effectiveness (CHCE). The panel described the opportunities and challenges involved in permanently repealing the SGR formula and moving away from traditional fee-for-service models in the context of past and ongoing Medicare health policy.

Eugene Rich, CHCE director, opened the forum and moderated the expert panel discussion, which included:

• Mai Hubbard, Mathematica Policy Research
• James Reschovsky, Mathematica Policy Research
• Robert B. Doherty, American College of Physicians (discussant)
• Stuart Guterman, The Commonwealth Fund (discussant)