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Congress Repeals Medicare Sustainable Growth Rate (SGR)

AMA SGR Fix

The Medicare Access and CHIP Reauthorization Act was adopted by a vote of 92 to 8 on the eve a 21 percent cut to physicians’ Medicare payments was set to take place. Instead, the bill provides positive annual payment updates of 0.5 percent, starting July 1 and lasting through 2019. Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect.

“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” AMA Executive Vice President and CEO James L. Madara, MD, said in a statement. “Patients will be able to get the care they need and deserve.”

In addition to addressing Medicare payment, the legislation outlines several provisions that should be beneficial for physicians, including:

  • Medicare’s current quality reporting programs will be streamlined and simplified into one merit-based incentive payment system, referred to as “MIPS.” This consolidation will reduce the aggregate level of financial penalties physicians otherwise could have faced.
  • Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
  • Incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds.
  • Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.

While the bill supports physicians who choose to adopt new payment and delivery models, it also retains Medicare’s fee-for-service model. Participation in new models is entirely voluntary.

 

Additional information

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