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Monday, January 13, 2014

CONGRESS RETURNS; SO DOES SGR FIGHT

The U.S. House and Senate have returned to session, and the March 31 deadline to act on Medicare’s faulty Sustainable Growth Rate (SGR) formula is back in the spotlight. When we last left our heroes, they had averted the 23.7-percent cut in physicians’ Medicare fees that was scheduled for Jan. 1 and approved a three-month, 0.5-percent increase through the end of March. (If only the current Medicare fee schedule were so easy to calculate. See the latest TMA e-tip on what Medicare will pay you in 2014.) At about the same time, the House Ways and Means Committee and the Senate Finance Committee passed bills to completely replace the SGR with a payment system that rewards quality over volume. The House bill provides 0.5-percent updates for three years, then freezes physicians’ Medicare payments for seven years. The Senate bill keeps payment rates the same through 2016, then imposes progressively deeper cuts starting at 4 percent in 2017 and increasing to 10 percent by 2020. Neither bill spells out how to finance its roughly $150 billion, 10-year price tag. Working with the Coalition of State Medical Societies, TMA is asking congressional leaders to keep the SGR repeal train moving but to make sure that it:

  • Provides positive automatic payment updates,  
  • Eliminates the fee-for-service program penalties, and 
  • Revises or eliminates adoption of the ICD-10 coding system.  


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