Which SGR bill will make it?

Rep. Michael Burgess' 1-year doc fix isn't the only bill that addresses SGR -- but it's the most likely to get passed.

We've mentioned that the Texas Republican has filed a brief bill in the House that would kick the SGR can down the road one year.

But our friends at CIPROMS remind us of something many people have forgotten: There's other SGR-related legislation floating around out there.

CIPROMS notes, for example, that H.R.5707.IH, the “Medicare Physician Innovation Act” introduced in May by Allyson Schwartz (D.-Penn.) and Joe Heck (R-Nev.). is still live, though dormant, resting in the House Subcommittee on Health. As opposed to Burgess' short bill, this one's long and complicated, particularly in the Medicare Physician Payment Reform section that establishes separate conversion factors for each medical specialty, etc.

The bill is pitched as a "permanent fix," but the text implies that the rate(s) will be fiddled with for years to come-- for example: "The Secretary shall consult and work closely with physician and other provider groups in the selection of [payment and delivery] models." Heck's press release mentions "annual positive payment updates for all physicians for four years."

In the Senate, there's Rand Paul's (R.-Ky.) "Access to Physicians in Medicare Act of 2012," which is almost as short as Burgess' -- the current formula would be replaced by this: "the update to the single conversion factor for each such year shall be the lesser of (A) the annual percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers for the year; and  (B) 3.0 percent."

It has the virtue of simplicity, though we can imagine the complaints from specialists who will think they're getting a raw deal because the flat rate doesn't take into account the vagaries of their busineses. Also, the bill comes with all kinds of ACA-repeal stuff, which we may take as a sign that the bill was introduced more for political effect than to achieve anything practical.

A Republican budget bill, introduced earlier this year by Paul Ryan (R.-Wis.) and stopped by Senate Democrats, included a "deficit-neutral reserve fund" for a permanent SGR fix -- but, as Aon Hewitt reported, "funding details [were] not provided." The Democrats proposed their own deficit-neutral reserve fund alternative which "like the Ryan budget... does not specify how policymakers would pay for an SGR fix," said the Center on Budget and Policy Priorities in its analysis. "It starts from a higher level of Medicare spending than the Ryan budget, however, allowing more room to offset an SGR fix with other Medicare cuts."

Considering all that, and knowing our elected representatives as you do, it's a safe bet that the most likely fix will be a temporary one.