Congress must also address the Sustainable Growth Rate, a complex formula that determines Medicare physician payments. The SGR is broken. It has not been effective at controlling the volume of physician services, largely because it does not distinguish between those doctors who provide high quality care to beneficiaries and those who provide unnecessary services. Physicians who provide the most efficient care are penalized under Medicare’s current payment system while physicians who order more tests or perform more procedures are paid more.
When Congress takes action, the solution should include repeal of the SGR, a plan to stabilize payments during a transition period and establishment of new payment models that tie reimbursement to patient-centered care and quality outcomes. These payment models should allow providers to choose the payment option that best fits their health care practices. Americans deserve a payment system that will actually work with the way that our country uses health care, one that recognizes the different types of care and rewards quality and value of each.
We are at a turning point in health care in America. The answers to the challenges we face will not be simple, but if we align how we pay for care with how we diagnose and treat patients, we can reach our goal of high-value health care for every patient.
John H. Noseworthy, M.D., is president and CEO of Mayo Clinic and a neurologist.
Terri Henderson, 6, center, whose mother is El Salvador, attends a rally with members of Congress at Union Station's Columbus Circle to announce the Restore Opportunity, Strengthen, and Improve the Economy (ROSIE) Act on July 29, 2014. The legislation provides incentives for government contractors to pay a living wage and other benefits that would help low-income workers.