The U.S. Congress has once again delayed implementation of the Medicare sustainable growth rate, heading off a 27.4 percent cut in payments to doctors.

However, postponement of the SGR through 2012 has infuriated many in the health care community because it avoids a permanent solution to the issue that has threatened massive Medicare payment cuts for a decade.

The American College of Physicians, along with three other groups -- the American College of Surgeons, the American Academy of Family Physicians and the American Osteopathic Association -- had, in the past month, intensely advocated members of Congress to resolve the SGR dilemma once and for all.

"We would like a permanent repeal of the SGR because it's a failed system that hasn't at all reduced health care costs," said Dr. Virginia Hood, ACP president and a professor of medicine at the University of Vermont. "It's only caused uncertainty for physicians and patients. Everyone we spoke to on both sides of the aisle feels it's a failed system. The only question is how it will be addressed, and there seems to be very little political will to address it in a permanent way."

The medical associations issued a joint statement after congressional leaders revealed the deal they had cut, which was included in legislation that extends a payroll tax holiday through the end of the year and provides additional financial assistance for the unemployed.

"Our organizations, representing nearly 400,000 physicians and medical student members, are deeply disappointed by the agreement in Congress to enact another short-term 'patch' that neither solves nor moves us closer to solving the Medicare physician payment crisis," the groups said in the statement.

They also noted that the payment cut mandated by the SGR will be even steeper -- about 32 percent -- by Jan. 1, 2013, the new date when it's scheduled to take effect.

"As a result, the threat to access will be greater, the budget price tag to eliminate the cut will be even higher and the barriers to comprehensive payment reform will be even steeper," according to the joint statement. "Real payment reform can't advance as long as physicians and their patients are facing the instability created by more double-digit SGR cuts just 10 months from now."

The SGR formula, enacted in 1997, first called for a payment cut in 2002, after increases in Medicare payments to physicians exceeded growth in the gross domestic product. Congress allowed that cut to go into effect. Since then, however, it has voted to delay scheduled cuts each year, concerned that physicians might start dropping Medicare patients. The anticipated payment cut has grown larger with every delay.

ACP and the other medical groups believe that Congress could have permanently ended the SGR using money in a fund, known as the Overseas Contingency Operations fund, that was established to pay for the wars in Afghanistan and Iraq. The idea was that money that may never be spent -- because the war in Iraq has ended and the war in Afghanistan is winding down -- could be used to eliminate a Medicare budget cut that legislators will probably never allow to take effect.

"We heard some criticism that OCO funds are a gimmick because they are not real dollars," said Dr. Yul D. Ejnes, chairman of the ACP Board of Regents. "But many of the budget projections out there assume there's going to be a 27 percent Medicare cut, and we know that's not going to happen, so in a way it's a gimmick as well."

Instead, congressional leaders paid for the $20 billion cost of delaying the SGR for 10 months by cutting other health care funding.

The most notorious cut involves a $5 billion reduction to scheduled funding for chronic disease prevention programs -- a move that prompted widespread criticism from an array of public health groups.

"Cutting the prevention fund is penny-wise and pound-foolish," Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in a prepared statement. "The chronic diseases and unhealthy behaviors the prevention fund is intended to address impose tremendous costs on our health care system and government budgets.

"Tobacco use alone costs $96 billion a year in health care bills," he said. "Health care costs are crippling our nation's economy. The commitment to preventing disease, not just treating disease, is critical to reining in America's health care costs."

The deal also deletes $2.5 billion in additional Medicaid money for Louisiana that was part of the Affordable Care Act, and further reduces Medicaid payments to hospitals.

ACP's leadership holds out little hope that any sort of reform of the SGR will take place given the current environment on Capitol Hill.

"Right now there doesn't seem to be any effective system to address any type of problem," Hood said. "There's a lot of political posturing that seems to be more important than addressing the important problems that are facing the nation."