publication date: Apr. 17, 2015

Lawmakers Repeal Medicare SGR in Bipartisan Vote

 

President Barack Obama signed the Medicare Access and Children’s Health Insurance Program Reauthorization Act on April 14, permanently repealing the Medicare sustainable growth rate formula.

The bill received overwhelming bipartisan support: The House of Representatives voted 392 to 37 on April 2, and the Senate approved it with a 92 to 8 vote April 14.

Originally enacted as part of the Balanced Budget Act of 1997, the SGR has been amended 17 times with short-term patches to prevent severe annual cuts to physician payments. A 21.2 percent rate reduction for all physicians was scheduled to take effect April 15.

“With Congress passing this historic legislation to finally end the 13-year SGR roller coaster ride, Medicare beneficiaries and their physicians can breathe easier knowing that they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients,” American Society of Clinical Oncology President Peter Yu said in a statement. “The Congressional bipartisan, bicameral leadership that forged this much-anticipated resolution has taken an important step to restore stability and confidence in Medicare.

“The American Society of Clinical Oncology looks forward to working with policymakers to ensure that this new law is effectively implemented and paves the way to new payment models that foster high-quality, value-based health care for all Americans with cancer.”

The bill’s Merit-Based Incentive Payment System and Alternative Payment Model payment structures will increase physician pay by 0.5 percent in the second half of 2015, and an additional 0.5 percent annually from 2016 through the end of 2019—the 2019 rates would be maintained through 2025 with no additional increases.

“Repealing the SGR has been an ASTRO priority for years, and passage of this legislation represents a long-awaited, historic victory for our patients,” said Bruce Haffty, chair of the American Society for Radiation Oncology board of directors. “Permanently repealing the SGR and replacing it with a stabilized reimbursement plan focused on quality will strengthen Medicare and allow us to enhance cancer care for the more than one million patients treated with radiation therapy each year.”

Current Medicare programs that reward electronic health records and quality reporting will be merged by 2019 to encourage participation and to reduce the administrative burden. The Children’s Health Insurance Program also received funding for two more years, and $7.2 billion was allocated for community health centers.

“[The bill restores] stability for physicians serving Medicare patients in communities across the country,” said Steven D’Amato, president of the Association of Community Cancer Centers. “ACCC thanks the legislators in both houses who voted in support of SGR repeal. We also salute our ACCC members for their persistent, multi-year advocacy efforts on behalf of SGR reform.”

Previous short-term SGR fixes have too often been paid for out of technical component reductions in diagnostic imaging, said Bibb Allen, chair of the American College of Radiology Board of Chancellors.

“It is long past time to put some stability into the physician payment system. However, infinite policy details must be worked out to ensure it is implemented appropriately,” Allen said in a statement.

“The legislation moves us away from fee-for-service to value-based alternative payment models, most not yet designed, but this is the future and the future is now.”

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