The Future of SGR: How Spine Surgeons Would Solve the Problem

Written by Anuja Vaidya | April 10, 2014 | Print  |

Here three spine surgeons discuss what they would like to see Congress do with Medicare's sustainable growth rate formula in an ideal world.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What are some ways to ensure spine surgery patient satisfaction?



Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 16, at 5 p.m. CST.



Question: Ideally, what would you like to see Congress do with sustainable growth rate or SGR? 


Brian Gantwerker
Brian R. Gantwerker, MD, Neurosurgeon, The Craniospinal Center of Los Angeles: I would like to see a temporary freeze of the SGR formula.  Payments would continue at the current reimbursement rate. Then, over the course of a two-year transition period, as part of cost of doing business, the private insurers "tithe" to the doctors to make up the difference from the governmental payment portion.  



I think the government should pay less of the Medicare portion and mandate, say, 30 percent rather than the customary 20 percent. 



Richard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute, Peoria, Ill.: In the ideal world, free markets would determine rates and the SGR would not exist. However, given the constructs of the current system, it should obviously be repealed. 



KubeThe system is inherently flawed. We continue to delay the massive cuts — latest would have been 24 percent — but nothing is really fixed. Given Medicare is typically a cash loss proposition in spine, allowing the cuts to occur will never happen without seniors having virtually no access to care. If we are honest enough to admit that the massive cut will never happen, we need to get serious about the alternatives. 



The goal is currently to cut costs and reduce payments which is at odds with an already cash negative model. Even the current modest yearly increases fall significantly short of the increase in cost to provide service. Unfortunately, the solution becomes increasingly complex which is the logical outcome with an economic system of price controls. Free markets would drive competition to deliver price and outcome, hence value.



Ara Deukmedjian, MD, CEO, Medical Director, Deuk Spine Institute, Melbourne, Fla.: SGR is a key determinant of physician reimbursement for the professional services we render to patients. If physicians' professional reimbursements are not stabilized soon and returned to a positive net annual change, society will continue to witness and experience a progressive deterioration in the health of this great nation as more physicians succumb to the unwieldy crushing pressure of escalating administrative and regulatory costs, denials by payers for medically necessary services, greater patient financial responsibility and exclusive payer networks. 


Ara Deukmedjian
Declining reimbursements are a tool being used by payers to force doctors out of private practice and into hospital employment. Once employed, doctors become easy to control by insurance companies through the façade of hospital employment. The insurance companies control the hospitals, who then control the doctors. Hospitals everywhere are choosing less costly — and lower quality — supplies and equipment due to strong downward pressure by health insurers threatening to exclude the hospital from payer contracts unless the hospital takes less and less money for medical services.



Hospital administrators, committees and policies can restrict employed doctors' ability to care for their patients by restricting access to necessary testing or treatments. This is happening everywhere in hospitals across the country under the guise of [the argument] 'healthcare costs are too high and out of control.' But the real problem is the shameless profiteering of our health insurance companies.



Record profits last quarter for all major health insurers and record number of denials for medical treatments and testing at the same time. Folks, we have bigger problems than the SGR here. The SGR is just a distraction from the real issues at hand — patients losing access to high quality care in America.


More Articles on Spine: 

Hospital for Special Surgery Names Dr. Todd Albert Surgeon-in-Chief
Costs for SI Joint Disruption, Sacroiliitis About $270M Over 5 Years
The Robotic Difference: How New Technology Could Impact Spine

The Future of SGR: How Spine Surgeons Would Solve the Problem

 

Here three spine surgeons discuss what they would like to see Congress do with Medicare's sustainable growth rate formula in an ideal world.

 

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What are some ways to ensure spine surgery patient satisfaction?

 

Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 16, at 5 p.m. CST.

 

Question: Ideally, what would you like to see Congress do with sustainable growth rate or SGR?

 

Brian R. Gantwerker, MD, Neurosurgeon, The Craniospinal Center of Los Angeles: I would like to see a temporary freeze of the SGR formula.  Payments would continue at the current reimbursement rate. Then, over the course of a two-year transition period, as part of cost of doing business, the private insurers "tithe" to the doctors to make up the difference from the governmental payment portion. 

 

I think the government should pay less of the Medicare portion and mandate, say, 30 percent rather than the customary 20 percent. 

 

Richard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute, Peoria, Ill.: In the ideal world, free markets would determine rates and the SGR would not exist. However, given the constructs of the current system, it should obviously be repealed.

 

The system is inherently flawed. We continue to delay the massive cuts — latest would have been 24 percent — but nothing is really fixed. Given Medicare is typically a cash loss proposition in spine, allowing the cuts to occur will never happen without seniors having virtually no access to care. If we are honest enough to admit that the massive cut will never happen, we need to get serious about the alternatives. 

 

The goal is currently to cut costs and reduce payments which is at odds with an already cash negative model. Even the current modest yearly increases fall significantly short of the increase in cost to provide service. Unfortunately, the solution becomes increasingly complex which is the logical outcome with an economic system of price controls. Free markets would drive competition to deliver price and outcome, hence value.

 

Ara Deukmedjian, MD, CEO, Medical Director, Deuk Spine Institute, Melbourne, Fla.: SGR is a key determinant of physician reimbursement for the professional services we render to patients. If physicians' professional reimbursements are not stabilized soon and returned to a positive net annual change, society will continue to witness and experience a progressive deterioration in the health of this great nation as more physicians succumb to the unwieldy crushing pressure of escalating administrative and regulatory costs, denials by payers for medically necessary services, greater patient financial responsibility and exclusive payer networks.

 

Declining reimbursements are a tool being used by payers to force doctors out of private practice and into hospital employment. Once employed, doctors become easy to control by insurance companies through the façade of hospital employment. The insurance companies control the hospitals, who then control the doctors. Hospitals everywhere are choosing less costly — and lower quality — supplies and equipment due to strong downward pressure by health insurers threatening to exclude the hospital from payer contracts unless the hospital takes less and less money for medical services.

 

Hospital administrators, committees and policies can restrict employed doctors' ability to care for their patients by restricting access to necessary testing or treatments. This is happening everywhere in hospitals across the country under the guise of [the argument] 'healthcare costs are too high and out of control.' But the real problem is the shameless profiteering of our health insurance companies.

 

Record profits last quarter for all major health insurers and record number of denials for medical treatments and testing at the same time. Folks, we have bigger problems than the SGR here. The SGR is just a distraction from the real issues at hand — patients losing access to high quality care in America.

 

More Articles on Spine:

Hospital for Special Surgery Names Dr. Todd Albert Surgeon-in-Chief

https://www.beckersspine.com/spine/item/20157-hospital-for-special-surgery-names-dr-todd-albert-surgeon-in-chief

Costs for SI Joint Disruption, Sacroiliitis About $270M Over 5 Years

https://www.beckersspine.com/spine/item/20141-costs-for-si-joint-disruption-sacroiliitis-about-270m-over-5-years

The Robotic Difference: How New Technology Could Impact Spine

https://www.beckersspine.com/spine/item/20112-the-robotic-difference-how-new-technology-could-impact-spine

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