SGR repeal gains momentum

Wednesday, February 12, 2014 03:41 PM

Another bill has been introduced in Congress that would repeal Medicare’s sustainable growth rate formula in advance of the March 31 deadline to prevent a 24.1 percent Medicare cut. Rep. Michael Burgess, MD (R-Texas), introduced the “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 4015/S.2000). It addresses the policy provisions related to eliminating the SGR but does not include financial offsets or any extender policies.

The AMA outlines some of the main provisions:

• The SGR would be repealed immediately.
• Positive annual payment updates of 0.5 percent would be provided for five years.
• The value-based payment program would be replaced with a similar Merit-Based Incentive Payment System or MIPS, which includes prospectively-set performance thresholds and offers flexibility in the imposition of performance requirements that are inappropriate for some specialties.
• The effective date of the MIPS program would be one year later than the original VBP proposal, and will start in 2018.
• The MIPS funding pool would be increased and no longer budget neutral, and the phase-in of penalty risks for those who fall in the lowest performance quartile would be capped at a maximum of 9 percent (as opposed to the previous 12 percent).
• The 5 percent added incentive payment for physicians in Alternative Payment Models was retained.
• Funding for technical assistance to small practices of 15 or fewer professionals was doubled.
• Provisions similar to the Standards of Care Protection Act were included.
• Physicians who opt out of Medicare to engage in private contracting with their patients would no longer be required to renew their opt-out status every two years.

The AMA congratulated House and Senate negotiators for this “critical step.”

“Congress has been debating the shortcomings of the SGR policy for more than a decade, and now a solution to this failed policy is finally at hand,” said AMA President Ardis Dee Hoven, MD. “It is time to take action, and to stop the cycle of short-term patches that merely address the immediate crisis posed by whatever cut is currently pending. Further reliance on this mechanism to preserve patient access to care is fiscally irresponsible and has impeded innovation in delivering health care services for far too long.”

After news that another short-term reprieve could be attached to a bill to raise the debt ceiling, the Colorado Medical Society joined other state medical societies and national specialty societies in signing on to an AMA letter to House and Senate leaders recommending against passage of another short-term patch. The letter cites great progress that has been made with the introduction of H.R. 4015/S. 2000 and urges Congress to build on this work.

Congress is now closer than it has ever been to enacting fiscally-prudent legislation that would permanently repeal the SGR. Amplifying the physician voice on the issue is now critical. Click here to send an e-mail through the AMA’s Fix Medicare Now website. Or call your lawmakers through the AMA’s Physicians Grassroots Network (PGN) hotline at (800) 833-6354.