Tag Archives: Sustainable Growth Rate (SGR)

President Obama Signs MACRA: Permanently Reforms Medicare Physician Reimbursement Framework, Includes Other Health Policy Provisions

Today President Obama signed into law H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.… Continue Reading

Senate Recesses Without Taking up House-Approved SGR Fix Legislation

The Senate has adjourned until April 13, 2015 without taking action on the House-approved Medicare Access and CHIP Reauthorization Act, which would repeal the Sustainable Growth Rate (SGR) formula, reform Medicare physician payments, and make other policy changes.  In the interim, the 21.2% physician fee schedule cut mandated by the SGR will be triggered for services furnished … Continue Reading

MedPAC Report to Congress on Medicare Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual recommendations to Congress on Medicare policies, including Medicare fee-for-service (FFS) payment updates and a status report on the Medicare Advantage and Medicare Part D programs. The following are highlights of the recommendations for 2016 (many of which were recommended previously):… Continue Reading

CMS Revises Down 1st Quarter 2015 Medicare Physician Fee Schedule (MPFS) Conversion Factor

CMS has posted a January 2015 release of the National Physician Fee Schedule Relative Value File, reflecting a conversion factor (CF) of $35.7547 – down slightly from the $35.8013 included in the 2015 final MPFS rule published on November 12, 2014.  CMS is expected to publish a notice explaining the reasons for the revised CF. … Continue Reading

Congress Approves “ABLE Act” with Medicare Offsets

On December 16, 2014, Congress gave final approval to H.R. 5771, a tax extender bill that includes the “Achieving a Better Life Experience (ABLE) Act of 2014.” The ABLE Act provisions allow individuals with disabilities to establish tax free savings accounts to pay for qualified expenses (e.g. medical, post-secondary education, housing, and transportation expenses). Prior … Continue Reading

Highlights from Reed Smith’s Post-Acute Care Conference

In early April, Reed Smith hosted an enlightening conference entitled "Reed Smith 2014 Washington Health Care Conference: Focus on Post-Acute Care" in Washington, D.C. The conference brought together a panel of experts to discuss episodic care, bundling models, and alternative payment and delivery systems, as well as other speakers to present from the perspective of investors and Capitol Hill. The conference was capped with a stimulating keynote address from American Enterprise Institute resident scholar Dr. Norman Ornstein on the current polarized nature of American politics, particularly in regards to national health policy.… Continue Reading

President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

On April 1, 2014, President Obama signed into law H.R. 4302, the "Protecting Access to Medicare Act of 2014" ("the Act"). The Act includes a one-year Medicare physician fee schedule fix that averts a nearly 24 percent payment cut set for April 1, 2014, but which falls far short of earlier hopes for full repeal of the current sustainable growth rate (SGR) formula. The Act also includes numerous other Medicare payment and policy changes, including skilled nursing facility value-based purchasing provisions, reforms to the physician fee schedule relative valuation process, a new framework for clinical laboratory payments, a variety of changes impacting imaging services, changes in the exceptions for long term care hospitals, and extension of certain expiring provisions. In other areas, the bill includes a one-year delay in the transition to ICD-10, changes to the timetable for Medicaid disproportionate share hospital cuts, and "front-loading" of the 2024 Medicare sequestration reduction.… Continue Reading

MedPAC Issues 2014 Report to Congress on Medicare Payment Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual report to Congress on Medicare payment policy, including payment update recommendations for all the major Medicare fee-for-service payment (FFS) systems, limited recommendations related to the Medicare Advantage (MA) program, and a status report on the Medicare Part D program. The following are highlights of the … Continue Reading

As End of 3-Month SGR Patch Approaches, Hope Fading for Permanent Fix This Month

The clock is winding down for Congress to pass Medicare sustainable growth rate (SGR) formula reform legislation before the latest temporary spending patch expires at the end of the month and doctors again face steep cut in Medicare physician fee schedule (MPFS) payments.  While there had been high hopes for a permanent reform once key … Continue Reading

Bipartisan/Bicameral SGR Reform Bill Released; Offsets Not Yet Identified

The bipartisan leadership of the House Energy and Commerce Committee, House Ways & Means Committee, and Senate Finance Committee have released a consensus Medicare physician fee schedule reform bill expected to be considered by Congress before the latest temporary payment patch expires at the end of March. Highlights of H.R. 4015, the SGR Repeal and Medicare … Continue Reading

Congress Approves 1-Year Extension of Medicare Sequestration

On February 11, 2014, Congress approved a one-year extension of Medicare sequestration cuts as part of a bill (an amendment to S. 25) to restore certain military retiree pension benefits.  Under the legislation, current 2% across-the-board cuts to Medicare provider payments would be extended through 2024 (instead of 2023).  While the savings from the sequestration … Continue Reading

SGR Reform/IPAB Connection – Will Medicare Physician Fee Schedule Fix Trigger IPAB Provider Cuts?

The Congressional Budget Office (CBO) has raised the specter that pending legislation to reform the Medicare physician fee schedule statutory update formula could increase the likelihood that the Affordable Care Act’s (ACA) Independent Payment Advisory Board (IPAB) mechanism would be triggered – potentially resulting in as much as $0.6 billion in Medicare provider cuts during … Continue Reading

House Panel to Examine Medicare “Extenders” Policy

On January 9, 2014, the House Energy and Commerce Health Subcommittee is holding a hearing on “The Extenders Policies: What Are They and How Should They Continue Under a Permanent SGR (Sustainable Growth Rate) Repeal Landscape?” The so-called extenders are measures that secure the continuation of various temporary Medicare payment and policy revisions impacting hospitals, … Continue Reading

President Signs 2-Year Funding Bill with Medicare SGR Patch, Sequestration Extension for Medicare Providers

On December 26, 2013, President Obama signed into law H.J. Res. 59, the Bipartisan Budget Act of 2013, which includes the Pathway for SGR Reform Act of 2013 ("the Act"). In addition to establishing federal budget targets for fiscal years (FYs) 2014 and 2015, the Act includes a number of provisions impacting the Medicare and Medicaid programs. Most notably, the Act provides a short-term reprieve from a looming Medicare physician fee schedule cut while lawmakers work to finalize a longer-term solution. It also extends Medicare provider payment cuts under existing sequestration authority for two years and makes a variety of other policy changes. The Act's major Medicare and Medicaid provisions are summarized in our full post.… Continue Reading

CMS Updates Medicare Physician Fee Schedule, Other Part B Policies for CY 2014

On December 10, 2013, CMS published its final rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014, which includes a 20.1% across-the-board cut in PFS rates in 2014 (down from 24.4% projected under the proposed rule). The cuts are largely due to the statutory Sustainable Growth Rate (SGR) update formula, … Continue Reading

Continuing Resolution for FY 2014 Adopted; Budget Panel Could Take Up Medicare Issues

On October 16, 2013, the House and Senate approved H.R. 2775, the Continuing Appropriations Act of 2014. Under the resolution, the federal government was reopened, after being closed since October 1, 2013. The resolution also funds government operations through January 15, 2014 and suspends the debt limit through February 7, 2014. In the only health … Continue Reading

CMS Proposes Updates to Medicare Physician Fee Schedule, Other Part B Policies for CY 2014

On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014. CMS projects that PFS payments will be reduced by approximately 24.4% in 2014, largely due to the statutory Sustainable Growth Rate (SGR) update formula (although … Continue Reading

July Health Policy Hearings

Recent Congressional hearings have addressed the following health policy issues: The House Energy and Commerce Committee has held hearings on Medicaid reform, implementation of the ACA, and reform of drug compounding regulations. An August 1 hearing entitled “PPACA Pulse Check” will feature testimony by CMS Administrator Marilyn Tavenner. The Senate Finance Committee held two hearings … Continue Reading

House Panel Invites Comments on Draft SGR Reform Legislation

The House Energy and Commerce Committee is inviting comments on advance draft legislation to repeal the Medicare physician fee schedule sustainable growth rate (SGR) formula and replace it with a system linking payment to quality of care.   Comments will be accepted until July 9, 2013.  In a related development, on July 10, the Senate Finance Committee is … Continue Reading

Health Policy Hearings

Recent Congressional hearings focusing on health policy include the following: The House Energy and Commerce Committee held hearings on health insurance premiums under the ACA and drug compounding. The House Energy and Commerce Health Subcommittee also held a hearing on "Reforming SGR (Sustainable Growth Rate): Prioritizing Quality in a Modernized Physician Payment System," which reviewed … Continue Reading