Proposed Legislation Would Repeal SGR

U.S. Reps Allyson Schwartz, D-Pa., and Joe Heck, DO, R-Nev., reintroduced on May 9 legislation that would repeal the sustainable growth rate (SGR) and award annual payment updates to physicians for providing seniors with high-quality care.

“For far too long we failed America’s seniors and created a long-term fiscal nightmare for Medicare by maintaining the status quo of the broken Medicare physician payment system,” said Schwartz in a press release. “Now is the time to fix the broken system once and for all by moving forward with a payment system that rewards quality and value, saves lives, and assures seniors’ access to the care they need.”

“The current sustainable growth rate formula has consistently produced unrealistic spending targets, which have threatened access to care for our seniors,” said Heck. “Congress has addressed the issue by providing temporary reimbursement patches that have left our Medicare providers wondering if they will be able to continue seeing patients.”

Last year, Congress averted a 27.4 percent Medicare payment cut to physicians in the Middle Class Tax Relief and Job Creation Act of 2012.

According to the House members, the Medicare Physician Payment Innovation Act would:

  • Permanently repeal the SGR formula and prevent a 30 percent cut to physician reimbursements scheduled for Jan. 1, 2013
  • Provide annual positive 0.5 percent payment updates for all physicians for four years
  • For years 2014 to 2017, provide an annual increase of 2.5 percent for primary care, preventive and care coordination services provided by clinicians for whom 60 percent of their Medicare allowable charges are for those same services
  • Institute a mandate for the Centers for Medicare & Medicaid Services (CMS) to issue no fewer than four health care delivery and payment model options by Oct. 1, 2016
  • Provide an alternative value-driven fee-for-service system for physicians unable to participate in one of CMS’ proposed payment and delivery models
  • Reward physicians who adopt new payment and delivery models and subject those who don’t to disincentives

As of May 9, this bill had been referred to Committee, but no further action has been taken.

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