Physician Practice

SGR permanent fix bill unveiled in Congress

Physician Practice Insider, March 24, 2015

Congress on Thursday unveiled its latest attempt to provide a permanent fix to the widely reviled Sustainable Growth Rate (SGR) funding formula that, if approved, would avert a 21% cut in Medicare reimbursements for physicians at the end of the month.

The sweeping package repeals the SGR and adds an automatic 0.5% payment update each year for five years. Proponents say it will stabilize Medicare payments to physicians. The bill also extends the Children's Health Insurance Program another two years.

It's not exactly clear how Congress would pay for the bill, which is estimated to cost between $175 billion and $200 billion. There has been speculation that some of the cost would be made up with means-tested Medicare premium increases on seniors and accounting maneuvers, and that some of the cost would be accrued to the federal deficit.

The House and Senate versions of the bill are nearly identical to failed legislation last year, but now there is reportedly bipartisan support in both chambers, according to a statement from the office of House Ways & Means Committee Chairman Paul Ryan (R-WI).

In addition to repealing the SGR, the bill would:

  • Restructure and streamline physician-led quality improvements that allow medical specialty societies to determine the most appropriate quality improvement metrics and strategies for use in quality initiatives.
  • Adopt flexible criteria that allow physician participation and engagement in delivery and payment models that are meaningful to their practices and patient populations, including preserving a fee-for-service option and recognizing the value of clinical data registries for improving quality.
  • Improve the fee-for-service system by streamlining Medicare's existing web of quality programs into one value-based performance program. It increases payment accuracy and encourages physicians to adopt proven practices.
  • Incentivize the use of alternative payment models to encourage doctors and providers to focus more on coordination and prevention to improve quality and reduce costs.

Read more in HealthLeaders Media.

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