I had the opportunity to chat with Rep. Michael Burgess, MD, for a good 20 minutes yesterday. Dr. Burgess, a self-described "simple country doctor," spent almost 30 years as a practicing OB/GYN in Texas before being elected to the U.S. House of Representatives in 2002. He sits on the powerful House Energy and Commerce Committee, and also serves on its Health subcommittee.
Dr. Burgess was the only Republican member of Congress to vote in favor of the House's health reform bill in 2009, which would've permanently eliminated the sustainable growth rate (SGR), the formula responsible for projecting an annual Medicare pay cut to physicians. It was a largely symbolic vote, because the bill had no hope of passage, Dr. Burgess said, but he cast it to show solidarity with the plight of physician practices who face uncertainty from the constant threat of major Medicare pay cuts. He ultimately voted against the final health reform legislation passed by Democrats on March 28.
Here's a transcript covering our conversation about the 21% Medicare pay cut hovering on the horizon, and why Congress has dealt with it in fits and starts this year.
Q. Is this year any different when it comes to a pay-fix, because of political sensitivity to deficits, because of health reform?
A. I haven't sat in on any of these behind-closed doors discussions, so I don't know what kind of deals there are between AMA and big medicine and [the White House]. I don't know if the AMA was promised a permanent SGR fix ... to support this health takeover.
Q. Do you believe we'll see a permanent SGR fix when the recess ends April 12?
A. I think the question is, is there something yet to come? Where maybe [Democrats want to] move the doctor fix far enough away from the health care bill so it doesn't look like the two are as related as they are. So they can pretend the cost of the fix isn't part of the cost of the health reform bill.
Q. Democrats have said that the health reform bill and an SGR fix are two separate issues, because SGR is a longstanding problem that would need to be dealt with regardless of whether the Obama administration pushed for health reform this year. You see them as one issue?
A. Absolutely ... how can you say you're going to make big changes to all of health care, but you're not going to address the doctor fix when you do that?
Q. You were the only Republican to vote for H.R. 3961 in October 2009, which would've repealed SGR and replaced it with a formula using two fee schedules. You've also introduced your own legislation to replace SGR with a formula based on the Medicare Economic Index (MEI). Why do you think there's been no support for these measures?
A. Everyone has their ideas on how doctors should be paid. I still intend to push for a permanent SGR fix ... The problem has to be fixed. It's just languished too long. The fault lies with both parties in Congress, I'd also fault big medicine in this case, because they should've fought for much, much more than they got in this big health reform deal.
Q. The House has approved a 30-day fix, but the Senate has not. Meanwhile the Senate has approved a 7-month fix, but the House has not. Which has a better shot of being passed when the recess ends?
A. The temptation [for Democrats] to put it off until after the elections [with a 7-month fix] is going to be pretty strong. For doctors, the longer the fix, the better. But the truth is, you need a much longer time horizon in a medical practice than even seven months, if you're looking at whether to hire a new physician or expand. These are decisions that are being put off by practices right now.
Q. Would you support the 7-month fix?
A. They're really not clean bills anymore, if they ever were, so that's difficult for me to say. Any new bill with a fix, would have to be looked at to see what else is in it.
Q. SGR was not really a partisan issue in previous years but now it doesn't seem to be?
A. I think you'll have supporters and detractors on both sides. The detractors will be because of the costs. I think it would've been so much easier if we'd tackled this seven or eight years ago, the numbers wouldn't be so daunting. But the truth of it is, we need to move on. This is money that we've already spent already, it's not like this is money that's still in the Treasury earning interest.