Senate adjourns without voting on bill to repeal sustainable growth rate

The U.S. Senate left for its 2-week spring break without voting on a bill that repeals the sustainable growth rate, leaving physicians to face a 21% payment cut if further action is not taken by March 31.

The House passed the bill on Thursday by a vote of 392 to 37.

The Senate returns on April 13.

The Centers for Medicare and Medicaid Services issued a message to Medicare providers on Tuesday.

“The negative update of 21% under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015. Medicare Physician Fee Schedule claims for services rendered on or before March 31, 2015, are unaffected by the payment cut and will be processed and paid under normal procedures and time frames,” the CMS statement said. “The Administration urges Congress to take action to ensure these cuts do not take effect. However, until that happens, CMS must take steps to implement the negative update. Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps.”

After the Senate adjourned, the American Medical Association released a statement expressing “extreme disappointment” that it did not vote on the bill.

“Their failure to act leaves physicians facing a devastating 21% cut in Medicare reimbursements when the current sustainable growth rate payment patch expires on March 31,” the AMA statement said. “The bill, which was overwhelmingly passed by the U.S. House of Representatives, eliminates the flawed SGR formula that all agree was a bad idea in the first place and advances innovative delivery and payment models that will help improve care quality, health outcomes and lower costs. The policy also assures access to care for children, low-income individuals and families by extending funds for the Children’s Health Insurance Program and community health centers."

“Physicians are always working to provide the highest quality of care for their patients, and the bipartisan bill passed by the House provides a clear pathway for them to do that. We urge the Senate to immediately address this issue upon their return and once and for all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”

The SGR, a key factor in annual Medicare physician payment updates, was adopted in 1997 to control physician spending by tying physician payment updates to the relationship between overall fee schedule spending and growth in the gross domestic product.

Since 2003, Congress has enacted a series of 17 short-term patches totaling almost $170 billion to forestall significant cuts in Medicare reimbursement.

The measure ensures a 0.5% annual physician payment update through 2019 and preserves and extends the Children’s Health Insurance Program through 2017. – by Matt Hasson