In an annual battle that has flared up every spring since 1997, Congress is once again considering the repeal and replacement of the Medicare sustainable growth rate (SGR), and this year’s potential legislation has significant impacts on CMS quality reporting programs and value-based payments.
WASHINGTON - The Patient-Centered Primary Care Collaborative (PCPCC) applauds the SGR Repeal and Medicare Provider Payment Modernization Act of 2015 (HR 1470). After 17 patches in 12 years, it is time to stabilize the Medicare physician payment system and provide health security to some of our most vulnerable members of the population who depend on consistent care from their health care providers.
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 Patient-Centered Primary Care Collaborative (PCPCC) submitted comments to the Center for Medicare and Medicaid Innovation on Advanced Primary Care Model concepts on March 16. In the comments, the PCPCC advocates for the transition from volume-driven fee-for-service payment to more value-oriented payment models in primary care linked to quality and efficiency.
View the PCPCC's complete responses in the PDF attachment.
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.
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.
Imagine having a team of health care professionals dedicated to keeping you healthy year-round by preventing the onset of diseases and managing your chronic medical conditions to avoid costly complications and hospitalizations.
That’s the mission of thousands of primary care practices nationwide that have embraced the “patient centered medical home” model that emphasizes prevention and disease management. Advocates say medical homes have the potential to improve quality, cut costs and reduce health inequities among all patients.
