Plan to Scrap SGR Moves Ahead
The proposed legislation would repeal the 1997 budget cap calculation called the Sustainable Growth Rate (SGR) and replace it with a .5 percent increase for each of the next five years as Medicare transitions to an alternate payment model. According to a fact sheet from the three committees, the transition will lead to an alternative payment model (APM) that would include the following:
- Participants who receive a significant portion of their revenue from an APM or patient-centered medical home (PCMH) 5 percent bonus.
- Participants need to receive at least 25 percent of their Medicare revenue through APM in 2018-19, with incentive increasing over time. The policy provides incentive to participate in private payer APMs.
- A new Technical Advisory Committee (TAC) will review and recommend physician-developed APMs based on criteria developed via open comment.
The new system also promises to consolidate three existing quality programs into one, implement a process to improve payment accuracy for individual provider services, focused on care coordination efforts for patients with chronic care needs, introduces physician-developed clinical care guidelines, and requires development of quality measures with stakeholders.
Long reviled for draconian cuts and last-minute fixes by Congress that totaled $150 billion in short-term patches, the SGR’s latest postponement lasts only until March 31st.
Senate Finance Committee Max Baucus hopes to have a deal wrapped up before his departure to China, where he will soon serve as ambassador.