5 ways health care will look different in the post-SGR era

Robert M. Wah, MD
Past President
American Medical Association
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Our nation stepped into a new era for health care last week when it adopted legislation to eliminate Medicare’s sustainable growth rate (SGR) formula.

Medicare had been locked in persistent instability thanks to this failed budgetary gimmick created in 1997. Yes, you read it correctly: 1997. That’s back when we were using dial-up connections, the general public was just becoming aware of the possible Y2K catastrophe and Google had yet to appear on the market.

For more than a decade, the unified voice of medicine tirelessly called on lawmakers to release Medicare into the 21st century. And now it has happened.

With SGR behind us, we now can build a forward-looking health care system that puts patients first—a system in which we can provide cost-effective care with top-notch health outcomes in a sustainable practice environment.

Here are five ways our health care system will begin to look different:

  • Medicare and TRICARE patients will no longer face constant uncertainty over whether they might lose their access to care.  The perennial threat of devastating payment cuts under SGR made it difficult for many physicians to know whether they would be able to keep their doors open for treating these patients.  
  • Physicians’ practices will be more sustainable. Under the new law, many of the competing quality-reporting programs in Medicare will be consolidated and better aligned. The risk of penalties also has been substantially reduced, and physicians now have potential for earning significant bonuses.    
  • The path will be cleared for new models of care. The new law not only removes the financial instability caused by the SGR formula but also provides monetary and technical support for those who choose to adopt new models of care suited to the 21st-century needs of physicians and their patients. One of our primary goals at the AMA is to further lift physicians’ regulatory burdens and provide practical resources to advance professional satisfaction and practice sustainability. Now that the SGR is out of the way, we can ramp up these efforts.   
  • Health outcomes will be improved in the clinic setting and the community.  Chronic diseases have become the primary sources of poor health and death today. Treating these conditions requires new approaches, and the new law permanently requires Medicare to pay for care management of these patients. We have an initiative underway that is developing ways physician practices can partner with their patients and the community to prevent two of the most common chronic conditions—heart disease and type 2 diabetes—before they start. We’re also advocating for Medicare and other insurance plans to cover evidence-based prevention programs. 
  • Physicians in training will be taught how to practice in the new health care environment. Even as the health care system undergoes dramatic change, an AMA consortium of medical schools is exploring how to prepare the next generation of physicians for practicing in the new environment. Students will learn how to succeed in new models of care, provide high-quality but cost-effective care, and team up with other health care professionals and the community so their patients can lead the healthiest lives possible.

Just as we partnered in the past to end an unsuccessful system that hindered our practices and threatened our patients, let’s step into the future together. Let’s shape this new era of health care into one in which our profession and our patients thrive.

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What about mental health care?
Will this make it easier for therapists, not medical providers, to receive referrals & reimbursement? I am both a Medicare provider & a Tricare provider (I signed a letter several years ago that I would be happy to see veterans or other military personnel who had Tricare & I responded yes & sent it back. With all the veterans we have, such long waiting lists when their physical & mental health needs are urgent, yet the actual time before they get help through the VA Hospitals, I think they should be allowed to see outside VA Hospital providers who are Medicare &/or Tricare providers. That's what would be in the veterans' & their families best interests & would save lives. Especially for those - I strongly believe virtually every soldier - who are suffering from PTSD. You would have to be a robot to not have PTSD after a war, any war, including these current ones!
This legislation sounds like a victory for all of us. <br/> May I further suggest that, following the old adage "An ounce of prevention . . . . ", both doctors and patients understand and begin to practice the proven benefits of a plant-based diet. <br/> Even steps in the right direction can help dramatically.<br/> Not only is a plant-based diet a benefit for the health of individuals, but also keeps down the rising costs of treating preventable diseases. <br/> Remember that the costs of our animal-based diet include catastrophic damage to the environment and the suffering of hundreds of billions of factory-farmed animals.<br/> Let's consider addressing the root of the problem. <br/> Thank you.
Doctors need to teach patients how to prevent diseases. Diet and exercise are the two most important factors in preventing disease.<br/> When an obese patient walks into your office with weight related illnesses give them a healthy plant based diet to follow along with a daily activity and most won't need pharmaceuticals which have dangerous side effects and can trigger even more illness. Why is this not being addressed? Are doctors afraid of "offending" people?
I think this is awesome! I am so pleased to have some good news!!!<br/> Now I would love to see help for Chronic Lyme patients who are left out in the cold. They are dying because they cannot afford treatment since the government doesn't recognize it. Can the AMA help????
First of all Halleluiah!! <br/> This is a great achievement in these times of austerity mongering.<br/> mommypowers asks what about mental health and I agree and would like to add what about dental health. <br/> As I understand it, bad dental health can cause many other maladies to emerge as a result of the bacteria and inflammation being generated. Also a unhealthy mouth reduces the ability to even ingest properly masticated food. That is, food well prepared for digestion and extraction of the maximum amount of nutrients from it.
I think it's great! Now, we need to have physicians make decisions about the duration of care that Medicare pays for e.g Medicare allows only for 19 visits for physical therapy (which amounts to approximately 9 weeks of therapy) when more is usually needed. Patients return year after year for the same therapy when a longer duration at ONE time in ONE YEAR might suffice.
I'm glad that the doctors and patients won. I've been paying into Medicare since that great buffoon LBJ was President. I don't want any tin horn politician messing with my Medicare or my Social Security. <br/> <br/> As for doctors' pay, they should earn high salaries. They deal with saving people's lives unlike lawyers like John Edwards who made millions destroying medical practices and hospitals.
I am a patient. Medicare has stopped paying for my Continuous Glucose Meter and supplies. Since I ran out of supplies on March 25th, I have had a terrible time controlling my Type 1 diabetes. It's like driving a car on a winding road with your eyes closed.
You need to teach physicians how to help people die with dignity. Many of today's physicians can't even talk about. Most medical people have the attitude that their job is to help people live as long as possible no matter what. They want to convince people to use all sorts of expensive, painful treatments just to extend a miserable life for a few months. People of sound mind don't want this and society can afford to waste precious resources like this either.


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