Will Congress's Latest "SGR Fix" Control Medicare Costs?
Congress is considering legislation that would replace Medicare’s current payment formula for physicians with one that rewards the delivery of “high value” care. But according to a new Commonwealth Fund–supported analysis in <em>Health Affairs</em>, the proposal’s shortcomings will need to be addressed for the new payment method to succeed.<br /><br />
Medicare’s current “sustainable growth rate formula,” or SGR, does little to discourage providers from ordering high-cost services for their patients instead of cheaper, equally effective treatments. But while the new approach creates incentives for specialists to participate in pay-for-performance and other alternative payment programs, it continues to undervalue preventive care and other relatively low-cost services, say analysts at Mathematica Policy Research. <br />
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While James D. Reschovsky and coauthors acknowledge that “correcting fee schedule valuations will be a substantial and controversial undertaking,” they argue “it is one that is vitally important to the SGR fix’s prospects for success.”<br />