Bipartisan Move Could Fix SGR Physician–Pay Problems

Abstract

WASHINGTON – Doctors could see a 0.5% pay increase for 5 years and a transition to alternative delivery and payment models under consensus legislation to repeal the Medicare Sustainable Growth Rate (SGR) formula. The legislation, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015), is based on three separate proposals approved last year by the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee. The new bill was introduced Feb. 6. It does not address how to pay for the SGR replacement. One recent estimate by the Congressional Budget Office put that price tag at $120 billion to $150 billion. Sen. Max Baucus (D–Mont.), chairman of the Finance committee, hailed the agreement. “This proposal would bring that cycle to an end and fix the broken system,” he said in a statement. “Our bill makes Medicare's physician payments more modern and efficient, and it will protect seniors’ access to their doctors.” American Medical Association President Ardis Dee Hoven, MD, commented that this consensus bill means that “Congress is closer than it has ever been to enacting fiscally prudent legislation that would repeal Medicare's fatally flawed sustainable growth rate formula.” “The proposed legislation is an improvement from previous versions in many respects, including a small yearly fixed increase in payment and a repeal of the SGR,” said AMDA Public Policy Commitee Chair Charles Crecelius, MD, PhD, CMD. “More importantly, it allows for mechanisms that will enable AMDA to work with [the Centers for Medicare & Medicaid Services] to transition to alternative delivery and payment -models that are specific to the needs of PA/LTC medicine. “While this legislation is not perfect for postacute and long–term care clinicians, it is a great improvement over the current status. It will also give AMDA the opportunity to weigh in on some of the reimbursement formulas for our -specific care setting as we move forward.” Several other physician groups also quickly endorsed the possible SGR fix. The American Geriatrics Society (AGS) said, “We are particularly pleased that the proposal includes a number of the policy priorities we advanced to improve the care of older adults” and highlighted: ▸Establishment of care–coordination payment codes to encourage management of chronic conditions.▸Technical assistance to help smaller practices improve quality and/or transition to alternate payment models.▸The extension of payment incentive eligibility to geriatrics team members including physician assistants, nurse practitioners, and clinical nurse specialists.▸A process to rebase misvalued codes.▸Development of quality measures in close collaboration with physicians. Charles Cutler, MD, chair of the American College of Physicians’ Board of Regents, said in a statement that his group is encouraged that the bill contains many important elements, including consolidating the three existing quality programs into a streamlined program that rewards physicians who improve care for seniors and implementing a process to improve payment accuracy. Reid Blackwelder, MD, president of the American Academy of Family Physicians said, “For more than a decade, the SGR has threatened our most vulnerable patients’ access to care by requiring drastic cuts in payment for medical services. By ending the annual, biannual, monthly, sometimes even bimonthly cycle of last–minute ‘fixes’ to prevent mandated SGR cuts, Congress will stabilize Medicare and bring peace of mind to their elderly and disabled constituents.” “Much work remains to create a system that can finally provide certainty to seniors and their doctors,” said Rep. Fred Upton (R–Mich.), chairman of the Energy and Commerce committee. The most recent cuts called for by the SGR were deferred as part of federal budget legislation enacted at the end of 2013. A short–term 0.5% increase in Medicare physician fees is slated to expire March 31.