Washington Watch: Congress Faces Key Deadlines
In July, the House of Representative’s Energy and Commerce Committee convened a markup of legislation to reform the Medicare physician fee schedule payment system. The Committee considered the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810), “a bill to amend title XVIII of the Social Security Act to reform the sustainable growth rate and Medicare payment for physicians’ services, and for other purposes.”
The legislation was introduced by Rep. Michael Burgess, MD (R-TX), and would repeal and replace the SGR with a new policy to change physician payment in two phases: (1) permanently repeal SGR and replace it with a five-year period of stable physician payments; and (2) create an Update Incentive Program that would link payments to quality of care. The legislation would also allow physicians to opt out of the fee for service (FFS) program and participate in alternative payment models (APMs). AAEM submitted comments to the Committee during the February and July periods in which it accepted input from stakeholder groups, and also weighed in with key members during the June Advocacy Day.
The Committee favorably reported the legislation by a roll call vote, with no members voting in opposition. The bipartisan vote may give Congress momentum to continue negotiations following the August recess, and vindicated the Committee’s strategy to focus first on the payment policy issues at hand and then make decisions regarding the difficult matter of offsetting the $139 billion cost of a permanent "doc fix" at a later date. However, after factoring in the other traditional Medicare “extenders” that are generally moved as part of a year-end package, the cost of a full SGR repeal package may rise above $170 billion. In recent years, Congress has enacted provider cuts to pay for a large share of the temporary fixes to SGR, but Congress faces pressure to find revenue in additional places to fund a package of this magnitude.
The issue of paying for the bill has still not been resolved, but Committee leadership has pledged that the legislation will be fully paid for when it comes before the full House for a vote. It is not expected that a bill will come to the floor earlier than October, given Congress’ focus on agency funding in advance of the fiscal year’s end on September 30. A number of key House and Senate members have signaled they would like to continue working towards SGR repeal because of the discounted cost of a permanent fix, but in the current fiscal environment it will be very challenging to identify offsets that are palatable to both Senate Democrats and House Republicans.
The current "doc fix" expires December 31, 2013. Following this date, physicians would face an approximately 25 percent Medicare reimbursement cut without Congressional intervention. The Senate held hearings this year to examine the physician payment system, but has not yet initiated Committee proceedings on legislation to permanently repeal the SGR.
House Continues to Advance SGR Repeal Proposal
In July, the House of Representative’s Energy and Commerce Committee convened a markup of legislation to reform the Medicare physician fee schedule payment system. The Committee considered the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810), “a bill to amend title XVIII of the Social Security Act to reform the sustainable growth rate and Medicare payment for physicians’ services, and for other purposes.”
The legislation was introduced by Rep. Michael Burgess, MD (R-TX), and would repeal and replace the SGR with a new policy to change physician payment in two phases: (1) permanently repeal SGR and replace it with a five-year period of stable physician payments; and (2) create an Update Incentive Program that would link payments to quality of care. The legislation would also allow physicians to opt out of the fee for service (FFS) program and participate in alternative payment models (APMs). AAEM submitted comments to the Committee during the February and July periods in which it accepted input from stakeholder groups, and also weighed in with key members during the June Advocacy Day.
The Committee favorably reported the legislation by a roll call vote, with no members voting in opposition. The bipartisan vote may give Congress momentum to continue negotiations following the August recess, and vindicated the Committee’s strategy to focus first on the payment policy issues at hand and then make decisions regarding the difficult matter of offsetting the $139 billion cost of a permanent "doc fix" at a later date. However, after factoring in the other traditional Medicare “extenders” that are generally moved as part of a year-end package, the cost of a full SGR repeal package may rise above $170 billion. In recent years, Congress has enacted provider cuts to pay for a large share of the temporary fixes to SGR, but Congress faces pressure to find revenue in additional places to fund a package of this magnitude.
The issue of paying for the bill has still not been resolved, but Committee leadership has pledged that the legislation will be fully paid for when it comes before the full House for a vote. It is not expected that a bill will come to the floor earlier than October, given Congress’ focus on agency funding in advance of the fiscal year’s end on September 30. A number of key House and Senate members have signaled they would like to continue working towards SGR repeal because of the discounted cost of a permanent fix, but in the current fiscal environment it will be very challenging to identify offsets that are palatable to both Senate Democrats and House Republicans.
The current "doc fix" expires December 31, 2013. Following this date, physicians would face an approximately 25 percent Medicare reimbursement cut without Congressional intervention. The Senate held hearings this year to examine the physician payment system, but has not yet initiated Committee proceedings on legislation to permanently repeal the SGR.
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