Washington—Finally, I can stop writing about the Medicare sustainable growth rate (SGR) formula and efforts to reform it, and you can stop worrying about whether you’re going to get whacked with untenable payment cuts about this time every year.
As you know, Congress finally came to its senses last month, passed the Medicare Access and CHIP Reauthorization Act (MACRA), and repealed the SGR, the hated formula that has determined Medicare payments to physicians since 1997. President Obama made it official by signing MACRA April 16.
Law marks end of long battle
It was a long battle for urologists and the organizations representing them. The AUA had lobbied heavily to repeal the SGR since 2002, when payment cuts under the formula first took effect. Last year, it appeared that a permanent solution and repeal of the SGR would be approved, but politics got in the way.
Encouraged by Congressional Budget Office estimates that significantly lowered the cost of repeal, the Senate Finance, House Energy and Commerce, and House Ways and Means committees each had approved their own proposals, but without offsets (provisions to pay the cost) by the end of 2013.
In February 2014, the three committees reached a bipartisan, bicameral agreement, but could not agree on how to pay the cost, then estimated at $144 billion through 2024. House GOP leaders, pressured by their conservative Tea Party members, decided to use the issue as a way to get at Obamacare.
So in March, they brought a replacement bill to the floor using a plan to delay Obmacare’s individual mandate penalties as an offset. But, of course, the White House threatened a veto. Finance Chairman Ron Wyden (D-OR) proposed using money saved from winding down the wars in Iraq and Afghanistan, plus some Medicare and Medicaid payment extensions, to pay the cost, but the Republicans would have none of that.
So then it was time for another temporary payment patch, which passed the day the previous patch expired, providing a 0.5% payment update for the balance of 2014, with those payment rates staying flat until April 1, 2015.