The fate of SGR repeal rests with the Senate

April 1, 2015

In this column, Daniel R. Shaffer of the AACU discusses the recent Urology Joint Advocacy Conference and how urology may have helped move the needle on a promising new SGR proposal.

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

Congress can act quickly when it wants to.

In early March, as urologists were preparing to attend the 10th annual Urology Joint Advocacy Conference (JAC), co-hosted by the AACU and AUA, the word on the street was that despite a great opportunity to repeal and replace the sustainable growth rate (SGR) formula in early 2015, Congress was likely going to enact another a temporary SGR patch or “doc fix” to address the March 31, 2015 expiration of last year’s temporary SGR patch.

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Much has changed, however, in the weeks since urologists visited Capitol Hill at the JAC. Right after the JAC, there were reports that senior House staff from both parties had been meeting and discussing a plan to permanently repeal and replace SGR. Soon thereafter, the House Energy and Commerce and Ways and Means committees released a joint bipartisan statement announcing that both committees were actively working to follow up on the work that they had done on SGR repeal and replacement in 2014, which included the introduction of last year’s SGR repeal and replacement legislation, H.R. 4015/S. 2000.

Less than a week later, on March 19, 2015, leaders in the House and Senate introduced H.R. 1470/S. 810, the “SGR Repeal and Medicare Provider Modernization Act of 2015,” legislation very similar to last year’s H.R. 4015/S. 2000. Five days later, bipartisan leaders of the House Energy and Commerce and Ways and Means Committees introduced H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which built upon the SGR repeal and replacement language of H.R. 1470/S. 810, adding offsets to help pay for SGR repeal and replacement as well as a number of other provisions not directly related to SGR repeal and replacement, like a 2-year extension of full funding for the Children’s Health Insurance Program (CHIP), set to expire September 30, 2015.

NEXT: A look at H.R. 2

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H.R. 2 has replaced H.R. 1470/S. 810 as the SGR repeal and replacement legislation actively being considered by Congress in 2015. Similar to last year’s legislation, H.R. 2 repeals SGR, provides for an initial 5-year period of annual 0.5% updates to physician payments, and replaces the prior system of penalties under PRQS, meaningful use, and the value-based modifier with a new consolidated Merit-Based Incentive Payment System, which would then be used in determining annual increases or decreases to physician payments beginning in 2019. The legislation also encourages physicians to join and participate in alternate payment models, offering bonuses and incentives to eligible physicians who do so.

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In addition to the provisions relating to CHIP, other provisions of H.R. 2 not directly related to SGR repeal and replacement include a number of Medicare and other health extender provisions, a delay of the “two-midnight” rule, and the “Protecting the Integrity of Medicare Act of 2015,” this year’s version of legislation that, according to its sponsors, helps strengthen Medicare’s ability to fight Medicare fraud.

Within days of its introduction, the House overwhelmingly approved H.R. 2 by a 392-37 vote on March 26. Following the House vote, the bill moved to the Senate. However, despite this overwhelming House vote, official White House support for H.R. 2 and the March 31, 2015 expiration of last year’s “doc fix,” the Senate adjourned for its 2-week spring recess on March 27 without bringing H.R. 2 up for a vote.

The Senate returns from its recess April 13, 2015, and Senate Majority Leader Mitch McConnell (R-KY) has stated that the Senate will take up H.R. 2 when it does. In the meantime, the March 31, 2015 expiration date stands and this year’s 21% cut to Medicare payments to physicians required under SGR technically went into effect April 1. The Centers for Medicare & Medicaid Services (CMS) did issue a statement prior to the House vote on H.R. 2 urging Congress to act in light of the March 31 expiration and explaining that CMS must take steps to implement the negative update required under SGR, but also noting that there are administrative delays in the processing of electronic and written claims for physician reimbursement.

Historically, when Congress has failed to timely act in advance of the effective date of cuts required by SGR, CMS has been able to delay the processing of payment claims in order to give Congress enough time to subsequently enact a legislative remedy to prevent those scheduled cuts from taking place. CMS expects to provide another update to physicians by April 11.

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Thus, the spotlight will be on the Senate come mid-April. It has been reported that some in the Senate are disappointed that CHIP funding was not extended for 4 years. Some are uncomfortable with increasing the share of Medicare Part B and D premiums that wealthier Medicare beneficiaries would have to pay under this legislation, one of the offsets used to pay for SGR repeal and replacement. Others are not satisfied that SGR repeal and replacement is not completely paid for by offsets in the legislation.

H.R. 2 is not a perfect solution, but it is a step that needs to be taken. That is why national physicians groups like the AACU, AMA, AUA, LUGPA, and the American College of Surgeons, among others, support H.R. 2 and urge its passage. It is time to put SGR to rest.

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