SGR repeal and the 2014 Joint Advocacy Conference: Timing is everything

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.

The 2014 Urology Joint Advocacy Conference (JAC), co-sponsored by the American Association of Clinical Urologists and the American Urological Association, turned out to be an opportune time for urologists visiting Capitol Hill. The JAC took place in Washington from March 9–11.

In February, after years of temporary “doc fixes,” leaders of the Senate Finance and House Ways and Means and Energy and Commerce Committees announced that they had reached a bipartisan and bicameral deal to repeal and replace the flawed sustainable growth rate (SGR), the so-called “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 4015/S. 2000). The legislation, as originally drafted, would repeal SGR and provide for a 5-year period of payment stability with annual payment updates for providers of 0.5% for years 2014 through 2018.

A new merit-based incentive payment system (MIPS) would be created, replacing and consolidating the three current incentive or merit-based programs and would be used, beginning in 2018, to make adjustments to provider payments. Professional organizations and other stakeholders would play a role in developing quality measures for MIPS. In addition, the legislation provides bonus payments to physicians who collect a certain percentage of their revenue from alternate payment models. The legislation has won the support of numerous medical associations around the country.

Though the legislation announced in February contains additional provisions, it does not address a very important issue-how to pay for SGR repeal-and this has become a major stumbling block in achieving a permanent legislative solution. The House subsequently passed a version of H.R. 4015 that seeks to fund SGR repeal with a 5-year delay of the Affordable Care Act’s (ACA) individual mandate. Meanwhile, the Senate discussed advancing S. 2000 with no “pay-fors.” Both ideas have been criticized as political ploys.

The previous “doc fix,” enacted in late 2013 to prevent 24% cuts to physician reimbursement under SGR from going into effect at the beginning of the year, was set to expire March 31. Despite bicameral and bipartisan support for H.R. 4014/S. 2000, the impending deadline and the outstanding pay-for issue were used by some to argue for another temporary patch, and as time slipped away, the momentum in Congress for a temporary patch grew. In late March, House Majority Leader John Boehner (R-OH) and Senate Majority Lead Harry Reid (D-NV) put together a deal that would again temporarily delay SGR cuts until March 31, 2015. Ultimately, this bill, H.R. 4302, passed both chambers, with the Senate voting its approval late on March 31.

There are many provisions in H.R. 4302 not related to the SGR issue. One that will provide some solace to a large number of physicians is the provision directing the Secretary of Health and Human Services not to adopt ICD-10 until Oct. 1, 2015, another issue that has been looming over the health care industry for quite some time.

During the JAC, undaunted by rumors of another temporary SGR fix, urologists descended on Capitol Hill on Tuesday, March 11, urging representatives, senators, and their staffs to keep the repeal momentum going and to achieve SGR repeal this year. In addition, urologists also advocated for reform of the U.S. Preventive Services Task Force, reform of graduate medical education to help address shortages in urology and specialty medicine, and preservation of the in-office ancillary services exception (IOASE) to the Stark law. The last of these is also a timely issue, as the elimination of the IOASE has been proposed by some as a way to help finance SGR repeal.

The JAC also provided urologists the opportunity to hear presentations from political analysts, policy experts, Hill staffers, and others. David Hawkings, senior editor of CQ Roll Call, opened the conference on Sunday, offering his impressions on the current environment in Washington and predictions for the upcoming 2014 elections. At the UROPAC luncheon on Monday, attendees heard from Michael Barone, senior political analyst for the Washington Examiner and resident fellow at the American Enterprise Institute, who discussed some of the political implications of ACA implementation and the battle over the Senate in 2014.

Congressman Andy Harris, MD (R-MD-1) was recognized for his work in health care and support for veteran victims of urotrauma and presented the AACU Russell B. Carson Memorial Lecture. David Hoyt, MD, executive director of the American College of Surgeons, discussed the health policy issues of importance to his organization and what it is doing about them. Attendees also heard advice on how to be better grassroots advocates on men’s health issues and a presentation on how Congress really works from Judy Schneider, specialist on Congress at the Congressional Research Service. These were just some of the speakers and topics at this year’s successful JAC.

Urologists were encouraged to continue to advocate on behalf of their patients and practices by meeting with their representatives and senators in district when they are back home, and to keep attending important conferences like the JAC each year. Urologists should continue to make their voices heard at the federal, state, and local levels throughout the year.