Optimism was running high this week that legislators would finally find a way to permanently repeal and replace the flawed sustainable growth rate (SGR) formula. Watching the leadership in the House come to a compromise was like waking up from the nightmare of government intransigence that has characterized U.S. politics lately.

And yet, as news broke on Friday that the Senate would not take up a vote on the bill that would eliminate the SGR until after their two-week recess—meaning we’ll be blowing right past that “deadline” for physician payment cuts—it was easy to wonder if the cooperation seen in the House was in fact actually the dream.

Senate Majority Leader Mitch McConnell (R-Ky.) tried to assuage fears by noting that the Centers for Medicare and Medicaid Services (CMS) would find a way to not initiate cuts in Medicare physician pay even after they are scheduled to go into effect on April 1.

"They can handle a two-week gap here," McConnell said. "I want to reassure everyone who's interested in this legislation we'll move to it very quickly when we get back. ... There's every reason to believe it's going to pass the Senate with a very large majority."

An earlier report from the National Journal speculated that a delay on action until mid-April might be in the cards, and CMS would likely just delay processing claims to buy more time. If the situation got really dire, physicians could be paid the reduced rate and then reimbursed the difference later, but that would cause all sorts of administrative headaches.

So as we wait even longer for a resolution to the SGR drama, let’s take a little trip down memory lane. Here’s some comments on the situation from over the years:

“Regrettably, we just don’t have the votes right now to fix this problem for good." - Senate Majority Leader Harry Reid (D-Nev.), 2014.

“In looking forward, the Congress urgently needs to decide on the basic direction of a future reimbursement system for physicians.” - Gail R. Wilensky, PhD, Health Affairs blog, 2008.

 “Unfortunately, the fixes legislated by Congress have all been makeshift measures that have actually served to increase the gap between target and actual Medicare spending in subsequent years, thus causing the SGR system to project ever more drastic cuts in physician reimbursement.” - Steven Wilk, MD, and Robert L. Phillips Jr., MD, MSPH, Family Practice Management, 2008.

“It's wrong to cut Medicare payments for physicians. We've avoided doing so through bipartisan short-term fixes in recent years, and we should continue that effort." - Sen. Edward M. Kennedy (D-Mass.), 2005.

And my personal favorite…

“It is possible that the Congress may look at this issue later this year as part of the overall discussion on Medicare reform issues. This report will be updated to reflect any legislative action.” - Jennifer O’Sullivan, Report for Congress, 2003.

You’ve got to admire the optimism.

-Evan Godt
Editor – Health Imaging