Good riddance, SGR: Urology groups, others react

April 23, 2015

Legislation that ends the sustainable growth rate (SGR) formula was hailed by leading urology groups as a historic, watershed event.

Legislation that effectively eliminates the sustainable growth rate (SGR) formula was hailed by the nation’s leading urology associations and others as a historic, watershed event that finally ends a “perennial menace to physicians,” in the words of one group.

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The AUA, LUGPA, American Association of Clinical Urologists, and others applauded the U.S. Senate for passing H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015" on April 14. The legislation was overwhelmingly passed by the House of Representatives on March 26.

The bill heads to President Obama’s desk, where it is expected to be signed it into law.

The bill marks a “rare bipartisan, bicameral initiative” to reform Medicare physician payments and marks the end of the fatally flawed SGR, the AUA said.

“Urologists, together with the rest of the healthcare community, are thankful to members of the House and Senate for passing this critical legislation and making Medicare reform a priority for the 114th Congress,” said AUA President William W. Bohnert, MD, in an AUA statement.

“We are grateful to the bill’s champions and their staffs, who worked tirelessly to develop a bipartisan agreement that not only reforms how physicians are paid by Medicare, but also enhances the program as a whole. A permanent fix to the SGR is essential to our ability to provide quality care to patients.”

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The AUA said it worked together with the Alliance of Specialty Medicine, the American College of Surgeons’ Surgical Coalition, and the American Medical for years to lobby on members’ behalf to repeal the SGR formula.

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“This landmark legislative victory, however, would not have been achieved without our physician advocates and their tireless outreach efforts to lawmakers,” the AUA statement said, noting that members sent more than 1,100 letters to elected officials during the 2 weeks leading up to the historic vote.

The Medicare Access and CHIP Reauthorization Act of 2015 stabilizes fee updates for physicians, including annual positive updates of 0.5% through 2019. It repeals the SGR formula and replaces it with a streamlined Merit-Based Incentive Payment System (MIPS) that will focus the fee-for-service model on providing value and quality, the AUA said. At the same time, H.R. 2 eliminates current penalties from the existing quality programs, such as the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Meaningful Use Program, and the Value-Based Modifier (VBM) Program beginning in 2019.

Also of interest to urology, the AUA said, are provisions that include the reversal of CMS’s decision to eliminate the bundling of 10- and 90-day global payments for surgical services, full EHR interoperability by 2018, and requirement of the Government Accountability Office to report on barriers to expanded use of telemedicine and remote patient monitoring.

LUGPA also credited Congress for doing away with the pay formula “that has plagued physicians and Medicare beneficiaries for years.”

“This represents a watershed moment for LUGPA as an organization, and individually for its member integrated urology group practices,” Gary Kirsh, MD, president of LUGPA, said in a news release. “This legislation encourages the development of comprehensive, coordinated health care-the very bedrock that our member groups are founded on.”

The revised payment structure encourages alternative payment methods (APMs) and the development of risk-sharing strategies between providers and payers. According to LUGPA, research has shown that independent physician practices are the lowest cost, highest quality provider of health care in such models. LUGPA member practices have already been adopting the infrastructure necessary to adapt to these payment models.

“This historic change ushers in a new era of healthcare delivery,” Dr. Kirsh added. “LUGPA will continue to be the definitive resource to assist physicians committed to integrated urology care.”

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The American Association of Clinical Urologists (AACU) issued a statement from Mark Stovsky, MD, MBA, AACU president, and Jeffrey Frankel, MD, health policy chair.

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While the legislative efforts to end the SGR have been a “roller coaster ride,” Congress has finally put an end to the “much-maligned physician reimbursement program that has been a perennial menace to physicians” and the subject of 17 ‘doc fixes’ over the course of its history.

“SGR repeal and reform has long been a legislative priority for the AACU, UROPAC, and all of urology,” the AACU statement said. “Other national, state and specialty organizations have also been advocating for the repeal and reform of SGR for many years. It is great to see all this advocacy work finally pay off! Our country's physicians and Medicare patients have achieved an important victory.”

The American College of Surgeons hailed the Senate action for ushering in much-needed Medicare reforms.

“The reforms set in place by Tuesday’s historic Senate passage of H.R. 2 offers peace of mind to America’s seniors, whose access to medical care through the Medicare program has been threatened for more than 10 years,” David B. Hoyt, MD, executive director of the American College of Surgeons, said in a statement. “The American College of Surgeons celebrates Congress’ bipartisan action making passage of the Medicare Access and CHIP Reauthorization Act possible.”

A statement by American Society of Clinical Oncology President Peter Paul Yu, MD, called the Senate vote “courageous.”

“Medicare beneficiaries and their physicians can breathe easier knowing that they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients,” Dr. Yu said.

“The congressional bipartisan, bicameral leadership that forged this much-anticipated resolution has taken an important step to restore stability and confidence in Medicare.”

The AUA said it will continue to educate its members on upcoming changes to the Medicare payment system and what they mean for practice. A section-by-section summary of H.R. 2 can be viewed here.

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