House committee releases bipartisan Medicare SGR reform bill July 25, 2013 Medicare Insurance/Reimbursement, Medicare, SGR, Advocacy, Sustainable Growth Rate 0 Three congressional committees have been hard at work over the past few months on legislation that would eliminate the desperately broken Medicare sustainable growth rate (SGR) formula that is used to determine physician payment rates. On Friday, the health subcommittee of the U.S. House of Representatives Energy and Commerce Committee's health subcommittee released its bill to repeal the SGR. One Tuesday the bill was approved by the subcommittee and now heads to the full committee for consideration. The House Ways and Means Committee and the Senate Finance Committee have held hearings on Medicare payment reform this year, but they have yet to introduce their bills. The bipartisan bill introduced would eliminate the SGR and provide a stable five-year transition period during which physicians would see annual payment raises of .5 percent. Starting in 2019, the bill would replace the current system with a fee-for-service model that calculates payment rates based on physicians' performance on quality measures as compared to their peers. Physicians would be scored on a scale of 1-100, and those in the top third would get an annual update of 1.5 percent, those scoring in the next third would get 1 percent and those in the lowest third would see a 0.5 percent payment cut. As an alternative to the fee-for-service track , the bill would also provide incentives for physicians to participate in alternative payment models, such as risk-adjusted capitated patient-centered medical homes, patient centered medical neighborhoods (for specialists), accountable care organizations, shared savings programs, case management fee for chronic disease programs or other models that combine fee-for-service with shared savings. These models are alternatives for physicians who do not want to participate in the fee-for-service quality reporting program. Physicians who do not participate in either the fee-for-service quality reporting program or alternative payment models would see their payments cut by 5 percent starting in 2019. Energy and Commerce Chair Fred Upton (R, Mich.) has said that he hopes that the bill can be approved by the full committee before Congress breaks for its summer recess in August. While the California Medical Association (CMA) has serious concerns with the legislation, particularly the penalties and the inadequate updates, we are pleased that Congress is moving forward with a bill to eliminate the SGR and establish a stable payment system that provides incentives for patients and physicians. It is crucial that Congress repeal the SGR this year. The bill continues to be a work in progress and CMA will continue to voice our position that there be appropriate payment updates for physicians. The bipartisan nature of this bill is notable. It was formally introduced by Congressman Mike Burgess (R-TX), a physician leader on the committee and is cosponsored by all of the committee Republican and Democratic leaders – Chairman Upton (R-MI), Subcommittee Chairman Pitts (R-PA), Ranking Minority Leaders Waxman (D-CA) and Pallone (D-NJ). California members on the committee include Lois Capps (D-Santa Barbara), Anna Eshoo (D-Santa Clara) and Doris Matsui (D-Sacramento), who are expected to support moving the bill forward. The bill meets many of the goals that CMA advocated to Congress including the elimination of the annual threat of nearly 30 percent SGR payment cuts, five years of stable updates, a continuation of the fee-for-service program with opportunities for updates and incentives to help physicians transition to new payment and delivery models. There are, however, many details that still need to be worked out. CMA is still working to include a payment locality (GPCI) update and has given Congress several options to move the outdated payment localities to Metropolitan Statistical Areas while mitigating the cuts to the rural counties. The bill does include a CMA-sponsored medical liability provision that will ensure that any new payment policies or practice guidelines contained in the Affordable Care Act (ACA) do not establish a new standard of care for medical liability proceedings. The bill does not include any funding sources at this point in time. Congress is waiting to get further agreement on the policy details before discussing how it will pay for the SGR repeal, which is expected to be the most controversial aspect of this bill. For more details on the bill, click here. Contact: Elizabeth McNeil, (800) 786-4262 or ecmneil@cmanet.org. Comments are closed.
