SGR remains in place—for now
Senate adjourns without acting on repeal legislation, but promises quick action when it returns from recess
It appears that the highly-anticipated repeal of Medicare’s Sustainable Growth Rate (SGR) formula—also known as the “doc fix”—will have to wait at least a couple of weeks longer.
The U.S. Senate adjourned for a two-week recess in the early hours of Friday morning without acting on legislation designed to eliminate SGR, despite the bill’s overwhelming approval by the House of Representatives.
Without Senate action on the legislation, physicians face a 21.2% reduction in their Medicare reimbursements. Senate Majority Leader Mitch McConnell (R-Kentucky) said, however, that doctors needn’t fear those cuts actually taking effect. “CMS [the Centers for Medicare and Medicaid Services] indicates they can handle this up to two weeks” McConnell said. “We’ll turn to this legislation very quickly when we get back. I think there is every reason to believe it’s going to pass the Senate by a very large majority.”
The legislation passed by the House, known as H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015, would, among other provisions:
- repeal the SGR formula,
- provide physicians with guaranteed annual 0.5% increases in Medicare reimbursements through 2019 and maintain them at the 2019 level through 2025,
- consolidate the Meaningful Use, Physician Quality Reporting System and Value-based Modifier programs into one program known as the Merit-based Incentive System, through which physicians and other professionals could earn additional payment adjustments,
- raise Medicare premiums for individuals with individuals with incomes between $133,500 to $214,000—with thresholds likely higher for couples—beginning in 2018
- extend the Children’s Health Insurance Program (CHIP) for two years, and
- make an additional $7.2 billion available to community health centers over the next two years
The legislation passed by a vote of 392-37.
Some senators have expressed concerns that the funding for community health centers could not be used to pay for abortions, while others have said they want the legislation to fund the CHIP program for four years, rather than two. Most observers believe those objections are not enough to derail the bill when the Senate votes on it.
Physicians’ groups, which had strongly supported H.R. 2, blasted the Senate for leaving town without acting on the legislation. “Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Robert Wah, MD, president of the American Medical Association, said in an email statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
David A. Fleming, MD, MACP, president of the American College of Physicans, said: “Doctors and patients must hold the Senate accountable for not passing SGR repeal and HR 2. They are allowing a 21 percent cut to go into effect on April 1. Furthermore, because the Senate didn't act, Congress has less than two days after recess to pass HR 2 and repeal the SGR before the 21 percent cut starts for April 1 claims.”
Robert Wergin, MD, president of the American Academy of Family Physicians, said: “The American Academy of Family Physicians is disappointed the Senate failed to pass this vital reform legislation before adjourning for two weeks… The U.S. Senate has the opportunity to make a historic reform to a system on which millions of Americans depend. The time to act is now. The House has provided an overwhelming bipartisan vote of approval. The Senate should do no less and should do so as quickly as possible.”