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Physician/Congressman Takes on Medicare Reimbursement.

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Michael Burgess, MD, is lead sponsor of a bill to replace the much maligned Sustained Growth Formula that is used to determine Medicare reimbursements.

U.S. Rep. Michael Burgess, MD, scanned the crowd gathered at the Brookings Institution for a discussion of Medicare physician payment reform and began his keynote address with a question.

"How many of you here are doctors?" he asked.

A smattering of hands went up.

"Okay, not enough of you," he said, as the crowd chuckled.

Burgess smiled and continued. "My dream is that one day I'll go to an Energy and Commerce committee meeting and there will be five doctors sitting on the panel discussing how we're going to pay economists in the future."

The joke gets a good laugh, but there's an element of seriousness behind the North Texas Republican's jest. As one of the few physician members of Congress, Burgess is dedicated to bringing the voice of the health care provider to the national policy debate. As evidence, look no further than his work to repeal the Sustainable Growth Rate (SGR), an issue he calls "critical to the future of America's patients."

Burgess is the lead sponsor of the Medicare Patient Access and Quality Improvement Act of 2013, which would replace the SGR with a 0.5 percent payment increase for physicians from 2014 through 2018. The bill was passed unanimously by the members of the House Energy and Commerce Committee, on which Burgess serves.

The proposal has since been combined with similar measures from the House Ways and Means and Senate Finance committees. The bill, called the SGR Repeal and Medicare Provider Payment Modernization Act, was announced in early February and has wide bipartisan and bicameral support. However, it does not identify any funding sources, which could be a major sticking point. Meanwhile, the clock is ticking, and physicians are growing increasingly angry about the lack of action out of Washington, D.C.

Burgess, an obstetrician-gynecologist, understands their frustration. Between the SGR and concerns about the potential implications of the Affordable Care Act, he has been hearing from a lot of disgruntled physicians these days.

"It seems like Congress has been at war with doctors for many years," he said. "And we're still a long way from resolution."

Doctor politician

Burgess, 63, was elected to the U.S. House of Representatives in 2003. He is one of 20 physicians serving in Congress, and is the founder and chairman of the Congressional Health Care Caucus.

He represents Texas' 26th district, which includes most of Denton County, located in the northern suburbs of the Dallas-Fort Worth metro area. He is a self-described conservative and a member of the Tea Party Caucus.

In addition to his role on the Energy and Commerce Committee, Burgess serves as the vice chair of two of its subcommittees: Health, and Oversight and Investigations. He is also a member of the Committee on Rules.

Burgess comes from a long line of doctors. His father was a surgeon who practiced at the Mayo Clinic in Rochester, MN, before moving his family to Texas. His grandfather was a prominent physician in Canada.

Initially reluctant to embrace the family business, Burgess had a change of heart as a college student and decided to apply to medical school. He was accepted into the University of Texas Health Science Center in Houston. He later went on to earn a master's in medical management from the University of Texas at Dallas, and was also awarded an honorary doctorate of public service from the University of North Texas Health Sciences Center.

Burgess spent more than 30 years as a practicing ob-gyn and never really considered running for public office. That changed dramatically after the events of September 11,2001.

"It definitely had a big impact on me," Burgess said. "I started looking for ways to become more active."

His desire to make a bigger difference first led him to run for the American Medical Association's House of Delegates. Burgess said he quickly discovered it wasn't the answer he was looking for, but he was inspired by a speech Texas businessman and former presidential candidate H. Ross Perot delivered at one of the meetings he attended.

Perot told the delegates that he gets hundreds of letters every day. Many of them he throws out without even opening. But if he received a notice from his physician, he was sure to read it, no matter how busy he might be.

Perot told physicians that they had a power, and that power should be used wisely.

"He told us that doctors are considered to be leaders," Burgess said. "People in your community listen to you and look to you for guidance and expertise."

So, Burgess began to toy with the idea of running for Congress. But winning wasn't going to be easy. For nearly 30 years, Burgess' district was represented by one man: Dick Armey, one of the primary authors of the "Contract with America," which was credited with helping a wave of Republicans get elected to the U.S. House of Representatives in 1994. Armey rode that success to a position as House Majority Leader.

Armey announced his decision to step down in 2002, but his son, Scott, was poised to run for the seat. Burgess, a longshot to begin with, figured his odds of winning were slim.

But in the months leading up to the election, the Dallas Morning News printed a series of articles that alleged Scott Armey, a judge, improperly used his position. Burgess went on to win a runoff against Armey with 55 percent of the vote, and later won the general election with 75 percent.

Burgess comes from a long line of doctors. His father was a surgeon who practiced at the Mayo Clinic in Rochester, MN, before moving his family to Texas. His grandfather was a prominent physician in Canada.

Burgess said his early days as a congressman were at times overwhelming. He found solace in an unusual place: the tiles that lined the walls of the underground tunnels connecting the House office buildings to the U.S. Capitol.

"They look just like the tiles at Parkland Hospital, where I did my residency," Burgess said, smiling.

SGR fix

After more than a decade in Congress, Burgess has passed through those tunnels countless times. His profile has been especially high recently, given the interest in SGR reform. Burgess also positioned himself as an outspoken critic of the ACA and, the website used for the federal health exchange.

The November day when he delivered the speech at the Brookings Institution was fairly typical for the Congressman, in that it was packed from 9 a.m. until after 7 p.m. with meetings, hearings and press interviews, including a live standup for The Willis Report on Fox Business.

After the Brookings speech, Burgess was interviewed by a reporter from who wanted to know more about the Senate's timetable for reviewing the SGR bill. During his address, Burgess revealed that the Senate hadn't scheduled markup until Dec. 11 - just two days before Congress left for the holidays. That meant it would be unlikely there would be any action on SGR in 2013.

Burgess didn't try to mask his frustration.

"If you don't fix the SGR, there arc a certain number of doctors of a certain age who are heading to the door," he said. "I need the Senate to do something. I need them to act."

After the interview, Burgess climbed in the back of an SUV to confer with his deputy chief of staff, James "J.P." Paluskiewicz, on the ride back to his office in the Rayburn House Office Building on Capitol Hill. The two discussed the topic of the day:, which was still experiencing glitches more than a month after it was officially launched.

The troubled website was the focus of Burgess' main hearing of the day, a meeting of the Oversight and Investigations subcommittee. The discussion was about an analysis conducted by McKinsey & Co. that foreshadowed many of the problems experienced by, and the panelist was Henry Chao, the Centers for Medicare and Medicaid Services deputy chief information officer and the project manager.

For more than two hours, the Republican subcommittee members grilled Chao about the report, demanding to know why the Obama administration didn't prepare more carefully for the website's launch in light of the McKinsey report.

Burgess asked Chao why he didn't ask for a delay, given the problems anticipated for the website.

"It didn't matter what the facts on the ground are," Burgess said. "Come hell or high water, we're going to launch.... It's like that old saying, 'Don't check the weather, we're flying anyway.'"

The subcommittee's Democratic members accused their Republican colleagues of sandbagging them with the McKinsey report, leaking it to the press before sharing it with them. They also emphasized the progress being made in fixing the technical glitches.

"We're not where we need to be, but we're seeing improvements," said Rep. Henry Waxman, D-CA, the committee's top Democrat. "Rather than just attack the health care law and try to undermine, we ought to try to make it work."

Burgess remained for most of the hearing before rushing off to another subcommittee meeting to discuss FDA regulation of mobile medical apps. After a quick lunch with political supporters, he returned to the House floor for a procedural vote on debate rules for oil and gas drilling bills. Then he was off to a meeting of the Rules Committee that reviews bills from all committees and decides whether, and in what order, to schedule them for consideration on the House floor.

"It's been a long day, and it's only 3 p.m.," sighed Burgess, as he eased into the subway car that shuttles members of Congress between the House office buildings and the Capitol. "If you're good, you walk. It's one of the only opportunities you get for exercise. But it's hard. Your feet get worn out"

By the time he returned to his office, representatives from the American Association of Clinical Endocrinologists were waiting to talk to him about SGR. There are several medical groups that preferred Burgess' proposal to the bill from the Ways and Means Committee. The main reason: The Ways and Means bill would freeze Medicare rates over the next 10 years but give incentive payments to doctors who meet certain performance measures, including moving away from the traditional fee-for-service model. Burgess' bill doesn't contain the freeze. It would continue to support fee-for-service, although it encourages the formation of new delivery models and rewarding reporting of quality data.

The most recent proposal is a combination of the two bills. In addition to permanently repealing SGR, the legislation provides an annual update of 0.5 percent from 2014 through 2018. The 2018 payment rates would be maintained through 2023 so physicians have time to receive additional payments through a merit-based incentive payment system. The agreement also provides a 5 percent bonus to providers who receive a significant portion of their revenue from alternative payment models.

Burgess said he's afraid abruptly eliminating fee-for-service would push older physicians out of the industry. With a physician shortage already projected, that's a risk he says he's unwilling to take.

Despite Burgess' efforts, there isn't a resolution yet. In early December, with time running short, Congress was forced to pass another three-month patch to Medicare reimbursement that was included as part of a bipartisan budget deal. But many believe a deal to repeal SGR can be reached by the time the patch expires in March.

Financial impact

There's a financial incentive for quick action; the price tag of a permanent fix has dropped dramatically. According to the Congressional Budget Office, the 10-vear cost of replacing the current SGR declined by more than half, from S297 billion to $117 billion for a o percent update and to $136 billion for a 0.5 percent update.

Burgess said he's hopeful it will happen this year. It would be a relief to finally fix the longstanding problem of Medicare physician reimbursement.

"It has been there, paralleling my career in public service, step for step," he said.

Despite his many obligations, Burgess enjoys interacting with his fellow clinicians. He began hosting a breakfast for physicians every Wednesday morning at 7 a.m. at the Capitol Hill Club shortly after being elected, a tradition he continues to this day.

There are 20 physicians in Congress, a dramatic increase from the six who were serving when Burgess first took office. But that is still a far cry from the 211 lawyers and 214 businesspeople who are members of the 113th Congress.

So why aren't there more physicians in public office?

"Most of us like our lives," Burgess said. "What's more satisfying than being a doctor? Even with all the troubles out there, it's still a very desirable profession. You get enormous job satisfaction."

At the moment, Burgess said he's planning to remain a public servant. He's up for re-election this year and has no immediate plans to step down.

He admits the atmosphere on Capitol Hill is rancorous at times and the constant criticism can be wearying. But in the end, the ability to make a difference on a national scale outweighs any potential downside.

"It's hard. It's time-consuming," Burgess said. "It means being away from your family. I wouldn't do it if I didn't think I was making a difference."

Carrie Johnson is associate editor of PEJ.
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Title Annotation:Profile
Author:Johnson, Carrie
Publication:Physician Executive
Geographic Code:1USA
Date:Mar 1, 2014
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