Thursday’s proposed repeal of the Sustainable Growth Rate woul give a 5 percent bonus to providers who receive a significant portion of their revenue from an alternative payment model or patient-centered medical home.
Participants need to receive at least 25 percent of their Medicare revenue through an APM in 2019-2020, according to Democrats in the Ways and Means Committee.
This threshold increases over time and the policy incentivizes participation in private-payer ATMs.
For more than 12 years Congress has sought a long-term solution to the flawed sustainable growth rate (SGR) formula. Over this time, the SGR has become one of the most dreaded terms in healthcare policy. It has no friends and is widely regarded in a bipartisan manner as a “mistake” and “failed policy.” Yet Congress finds itself in a familiar place – struggling to pass a permanent repeal of a failed policy it largely abhors.
The proposed bipartisan House deal to repeal and replace Medicare'shated sustainable growth-rate physician-payment system offers Republicans a chance to make two significant benefit changes they've long sought. Now it remains to be seen if they can accept and lock in that victory.
It also raises the question of what Democrats, if they help enact the SGR bill, would have left to offer when Republicans come back the next time—probably quite soon—with more and bigger demands to revamp and reduce Medicare spending.
A permanent "doc fix" plan—negotiated by House Speaker John Boehnerand Minority Leader Nancy Pelosi—will need to gain traction in the coming days if it's going to have a realistic shot at enactment.
That's because both the House and Senate need time to consider a permanent fix before Congress adjourns for spring break at the end of the month.
Congress has until March 31 to take action on the issue. Otherwise doctors would face a 21.2% decrease in payments for treating Medicare patients.
The ACP's Bob Doherty warns of looming funding cuts to vital healthcare programs and services.
Just about everyone in Washington knows that the Medicare SGR formula is about to cut payments to physicians by 21% on April 1, unless Congress overrules it. How many know, though, that primary care physicians are also facing a scheduled Medicare cut of 10% on Jan. 1, 2016, unless Congress overrules it, which would be in addition to the SGR cut? Not too many, I suspect.
Democratic senators would oppose a potential House bipartisan deal preventing cuts in physicians' Medicare payments if it doesn't finance a children's health program for four years, senior Senate Democratic aides said Sunday.
The aides issued the threat as House bargainers try preventing a 21 percent reduction in doctors' Medicare reimbursements scheduled for April 1. Negotiators want to craft an agreement annulling a 1997 formula that annually threatens deep cuts in those payments.
A proposed congressional "doc fix" deal will include a permanent repeal ofMedicare's sustainable growth-rate formula and a two-year extension of theChildren's Health Insurance Program with a total cost exceeding $200 billion.
Only a portion of the cost will be offset by spending cuts, said four lobbyists familiar with the negotiations. Funding a permanent fix has stymied Congress during past attempts to move beyond a temporary patch for the issue, as was done last year.
The deadline for Congress to act on the sustainable growth rate is fast approaching, with most policy watchers agreeing another “doc fix” override is likely.
If Congress doesn’t act, starting on April 1, physicians who accept Medicare would get a 21.2 percent pay cut as mandated by the sustainable growth rate formula for Medicare payment.
Congress is attempting to repeal its own SGR formula, using last year’s proposals as the framework, according to Health Affairs, a leading journal of health policy.
Aides to top House Republicans and Democrats are trying to negotiate a bipartisan compromise to permanently revamp a law that annually threatens cuts in Medicare payments to doctors, including a 21% reduction set to take effect April 1.
As part of the talks, bargainers are considering budget cuts that could offset part, but not all, of the measure's costs, according to lobbyists following the negotiations. The estimated 10-year price of repealing the annual Medicare cuts is roughly $175 billion.
Members of the House Energy and Commerce Subcommittee on Health are working on yet another attempt to reform the unpopular Sustainable Growth Rate (SGR) formula, according to Healthcare Finance News.
