WASHINGTON –A bill with bipartisan sponsors has been introduced in the U.S. House of Representatives to permanently repeal Medicare’s Sustainable Growth Rate formula.
Rep. Joe Heck (R-Nev.) and Rep. Allyson Schwartz (D-Penn.) unveiled their proposal at a briefing with reporters on Feb. 6. They were surrounded by supporters, including representatives from the American College of Physicians, the American Academy of Family Physicians, the American College of Osteopathic Family Physicians, and the National Coalition on Health Care.
In addition to repealing the SGR, the bill also "stabilizes the current payment system for physicians," said Rep. Schwartz, who added that it also "aggressively" tests new payment and delivery models and rewards high value, high quality health care.
Rep. Schwartz and Rep. Heck, an osteopathic physician trained in emergency medicine, also introduced the bill in the last Congress. But both said that they think that legislators are primed to act, in part because of the struggle to reduce health care spending and the deficit.
If the SGR is not replaced or repealed by the end of the year, physicians will see a 27% reduction in pay beginning in January 2014. Each year the cuts are delayed merely adds more on to the final tally for fixing the formula, noted Rep. Heck. The Congressional Budget Office estimated in its latest economic outlook released on Feb. 5 that it would cost about $138 billion to permanently repeal the SGR. That’s less than the $245 billion in previous CBO estimates.
"The time right now is perfect to finally pass this legislation," said Rep. Heck.
Joseph J. Heck
"I think the imminent process of sequestration may add a little urgency to reform because across the board cuts are not going to get us where we need to go," said John Rother, president and CEO of the National Coalition on Health Care, an umbrella group representing medical societies, businesses, unions, health care providers, religious associations, insurers, and consumers. "And the alternative here is smarter and much more oriented toward value, and it provides a very practical and beneficial alternative to the kind of meat-axe approaches in sequestration," Mr. Rother said.
Physician groups said they are hopeful that the proposal has legs this year. Dr. Carla H. Ginsburg, AGAF, chair of the Public Affairs and Advocacy Committee for the AGA said, "The AGA applauds Rep. Schwartz and [Rep.] Heck for offering a bipartisan plan to address the broken Medicare physician payment system and transition physicians into a system that rewards physicians for improved quality and efficiency....However, we are concerned about any proposal that penalizes physicians who remain in a fee-for-service model. It is important to recognize the variations in practices and diversity both geographically and in size of practice and to provide physicians with options of delivery models that may work best for them. "
Dr. Chuck Cutler, chair-elect of the ACP Board of Regents, said that "the stability that this bill brings to the marketplace and to our practice is particularly encouraging." He also said that the ACP was happy that the bill would maintain 2013 payment levels through the end of 2014 and then provide "positive and predictable updates" through 2019.
That is especially important as physicians test out new delivery and payment models, said Dr. Cutler.
From 2015 to 2018, the bill calls for annual increases of 2.5% for primary care, preventive, and care-coordination services. All other physicians would get a 0.5% increase for the 4-year period.
By 2019, physicians who continue to use a volume-drive fee-for-service model would get a smaller increase than would those who have transitioned to new models.
In addition to the groups who participated in the briefing, the bill also is supported by the American College of Obstetricians and Gynecologists, the Society of Hospital Medicine, the American College of Rheumatology, the American College of Cardiology, the American Academy of Neurology, and the American Academy of Pediatrics.
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