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House passes bill to repeal sustainable growth rate
Senate adjourns for recess without taking action on the bill.
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By a vote of 392 to 37, the U.S. House of Representatives passed a bipartisan bill on March 26 that repeals the sustainable growth rate, a key factor in annual Medicare physician payment updates, and replaces it with a merit-based payment system.
Support for the bill was virtually even along party lines, with 212 Republicans and 180 Democrats voting for the measure. The U.S. Senate, meanwhile, left for its 2-week spring break without voting on the bill, leaving physicians to face a 21% payment cut as of March 31.
The Senate was scheduled to return on April 13.
The bill, introduced in the House and Senate on March 19, ensures a 0.5% annual physician payment update through 2019. The new payment structure takes effect in 2019.
On March 24, the American Medical Association and Military Officers Association of America called on Congress to repeal the SGR and preserve access to health care for military families and seniors, according to an AMA press release.
“As a physician who served in the military, I understand how important TRICARE is for service members and their families,” AMA President Robert M. Wah, MD, said in the release. “These Americans, who sacrifice so much for our country, deserve to have the security that they will be able to access care when they need it. It is time for policymakers to seize the moment to finally eliminate the SGR once and for all and put in place new policies that support the implementation of new delivery and payment models that will improve care.”
After the Senate adjourned, the AMA 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.”
In a statement, David W. Parke II, MD, CEO of the American Academy of Ophthalmology, said, “This [the House vote] is certainly a pivotal moment for medicine. What is transpiring right now are the results of over a decade of extraordinary advocacy efforts by the Academy, its members and other physician groups. Repealing the SGR would provide the stability of annual increases in reimbursements and preserve a value-based, fee-for-service system. While not a perfect bill, repealing the SGR would allow physicians to move forward and focus on other unresolved issues under a value-based performance system, such as how to measure quality performance appropriately and meaningfully use electronic health records. The Academy’s IRIS Registry offers a unique tool to help solve these issues. The Academy stands with medicine in urging the Senate to quickly pass legislation that would permanently repeal the SGR. We have never had a more opportune time to improve the Medicare physician payment system.”
The SGR, adopted in 1997 to control physician spending, tied 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 Merit-Based Incentive Payment System (MIPS) consolidates the three current Medicare incentive programs: Physician Quality Reporting System, Value-Based Payment Modifier and Meaningful Use of electronic health records.
The MIPS will assess performance in four areas: quality, resource use, EHR meaningful use and clinical practice improvement activities.
The bill offers financial incentives for providers to participate in tests of alternative payment models.
The bill also preserves and extends the Children’s Health Insurance Program through 2017. – by Matt Hasson
Editor’s note: Please check Healio.com/OSN for the latest updates on the repeal of the SGR and physician payment cuts in Medicare.