What Congress Might Do
Congress agrees with us in concept. On a bipartisan, bicameral, across-the-board basis, thanks to years of outreach, nearly all federal lawmakers support SGR reform. For many, it is a priority. Most are tired of temporary annual fixes. It helps that the “price tag” for repeal as calculated by the Congressional Budget Office has dropped from $316 billion just over a year ago to “only” $138 billion now. This bargain is due to slowing in the rate of Medicare spending.
The tangible result of the efforts of physicians and other health professionals is the SGR reform initiative in the U.S. House and Senate, which remarkably has both strong bipartisan support and support in both chambers. This year, the ACR was asked seven times by congressional committees to provide feedback on SGR reform legislation, and seven times we responded promptly and vigorously with our recommendations. This is a real product of strong ACR presence on the Hill and at the Centers for Medicare and Medicaid Services. We continue to weigh in with leaders to try to further hone and improve their initiatives, which was in discussion draft form at the time of my writing this column.
As currently drafted, the evolving SGR repeal plan would:
- Finally repeal the SGR;
- Prevent the 25% cut scheduled for January 1, 2014;
- Keep fee-for-service as a payment option for providers;
- Provide opportunities for updates if providers score well in the Value Based Payment program;
- Provide opportunities for updates if providers participate in an Alternative Payment Model;
- Provide no automatic payment updates for the first ten years due to budget constraints;
- Repeal PQRS, Value-Based Modifier, and Meaningful Use penalty programs, and streamline efforts into one Value Based Payment program;
- Provide support for small practices to help with implementation; and
- Provide support for quality measures development by societies.
The ACR is asking for automatic increases, in addition to several improvements to the Value Based Payment program, and several other modifications. We have asked to tie updates to the Medical Economic Index, and we have also argued for an update of at least 2% higher than the baseline for those providers who primarily provide evaluation and management services for patients. This would serve to benefit and buttress those specialties and subspecialties like rheumatology that are not procedurally focused but who instead evaluate, coordinate, and manage the conditions and care of patients with chronic illnesses.
