At the July 21 hearing of the Ways and Means Health Subcommittee, I was encouraged that Chairwoman Johnson acknowledged the need to eliminate the Sustainable Growth Rate (SGR).   Whatever reimbursement system this Congress enacts as a replacement for SGR must fully recognize the costs of providing care;  if it does not, Medicare beneficiaries will continue to face diminished access to care.

American physicians provide the highest quality care in the world.  At the same time, Congress can take steps that will help us recognize where improvements can be made. Implementing any successful pay-for-performance system will take time.  According to the Johnson bill, actual reporting of performance will not begin until 2007, and a full medical inflation update would be available to those who report data in 2007 and 2008.    

But providers are facing a cut of 4.3 percent that would begin in just 5 months.  Physicians and other providers who bill Medicare directly need immediate relief from the sustainable growth rate, which is universally recognized as flawed.    The Medicare Payment Assessment Commission (MedPAC) has recommended an increase of 2.7% next year, but this bill only provides an increase of 1.5%.  This is inadequate, and I would urge the sponsors of the bill to adopt MedPAC’s recommendation. 
      
As our hearing demonstrated, many questions about the process of evaluating and promoting quality remain to be answered.  Congress must ensure that quality measures are appropriate and that physicians are not discouraged from treating more difficult, complex cases or from accepting patients with cultural, language, economic, or other barriers that might hinder compliance. 

Racial and ethnic disparities in health care access and quality exist even when economic and insurance factors are controlled for.  Many groups, such as racial and ethnic minorities and persons with disabilities, require much more intensive health care services for a variety of reasons, including a lack of  preventive care.   On the average, minority populations–African Americans, Latinos, and Native Americans-- already have severely reduced access to care, and doctors who are willing to treat them should be encouraged to do so, rather than penalized.   We must also ensure that the process of developing standards incorporates the input of groups such as the National Medical Association and the National Hispanic Medical Association, which represent the interests of minority providers and patients.