New hope for SGR re­peal

Low­ered cost es­ti­mate could fi­nally mo­ti­vate a fix

Modern Healthcare - - LATE NEWS - Jes­sica Zig­mond

Mo­men­tum is build­ing among House lead­ers to draft and in­tro­duce leg­is­la­tion this year that would re­peal Medi­care’s trou­ble­some sus­tain­able growth-rate for­mula used to pay physi­cians, but up­com­ing bud­get bat­tles could thwart those ef­forts.

In­dus­try lead­ers were sur­prised on Feb. 5 when the non­par­ti­san Con­gres­sional Bud­get Of­fice es­ti­mated that the new cost to re­peal the SGR and freeze physi­cian pay­ments for the next 10 years is $138 bil­lion, a more than 40% drop from its Au­gust 2012 pre­dic­tion of $245 bil­lion. Tes­ti­fy­ing be­fore the House En­ergy and Com­merce Health Sub­com­mit­tee hear­ing Feb. 14, Glenn Hack­barth, chair­man of the Medi­care Pay­ment Ad­vi­sory Com­mis­sion, at­trib­uted the lower score to a cur­rently low pe­riod of growth in uti­liza­tion of ser­vices. “SGR is on sale now,” Hack­barth said. “But the sale may not last for­ever.”

In the same week that the CBO re­leased its score, House En­ergy and Com­merce Com­mit­tee Chair­man Fred Up­ton (R-Mich.) and House Ways and Means Com­mit­tee Chair­man Dave Camp (R-Mich.) to­gether re­leased a frame­work that calls for re­peal­ing the SGR and re­plac­ing fee-for-ser­vice pay­ments with a sys­tem that re­im­burses physi­cians in a way that re­wards qual­ity and ef­fi­ciency. Ac­cord­ing to the com­mit­tee, in­dus­try stake­hold­ers have un­til Feb. 25 to com­ment on the pro­posal.

Dr. Jef­frey Lazarus, pres­i­dent of the Amer­i­can Med­i­cal As­so­ci­a­tion, told Mod­ern Health­care that he’s en­cour­aged not only be­cause of the CBO’s re­cent pro­jec­tion to fix the SGR, but also be­cause ac­tiv­ity sur­round­ing the is­sue is hap­pen­ing so early in the year. “We had Chair- man Up­ton tell us he was hope­ful he’d have a bi­par­ti­san bill be­fore Au­gust,” Lazarus said. The AMA con­cluded its an­nual ad­vo­cacy con­fer­ence in Washington on Feb. 13, where Up­ton served as a speaker.

Dan Bos­ton, ex­ec­u­tive vice pres­i­dent and prin­ci­pal at con­sult­ing firm Health Pol­icy Source, said House law­mak­ers on both com­mit­tees could pro­duce a joint leg­isla­tive pro­posal by late March with a bill ready for a vote by the Au­gust re­cess. “As much as there can be an align­ment of stars on this is­sue for them, this is it,” Bos­ton said, re­fer­ring to both cham­bers of Congress.

But Anders Gil­berg, se­nior vice pres­i­dent at the MGMA, said that while the new CBO es­ti­mate cre­ated an im­pe­tus for Congress to act, that pro­jec­tion comes at a time when law­mak­ers are ready to dive into a se­ries of bud­get bat­tles. He said how law­mak­ers work to­gether to ad­dress up­com­ing au­to­matic spend­ing cuts—known as se­ques­tra­tion—will serve as a good in­di­ca­tor on whether they can col­lab­o­rate on fix­ing the SGR.

“If they can’t come to­gether on the se­ques­tra­tion is­sue,” Gil­berg said, “it doesn’t bode well for them to do any­thing on SGR, re­gard­less of the price.”

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