So long, SGR: Congress (finally) repeals formula


Finally, I can stop writing about the Medicare 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.

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Congress finally came to its senses last month, passed the Medicare Access and CHIP Reauthorization Act (MACRA), and repealed the SGR, the hated formula that has determined Medicare payments to physicians since 1997.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.

READ: Urology groups reiterate support for USPSTF bill

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.

NEXT: AUA sent nearly 1,400 letters urging repeal


Following the congressional elections last November, when Republicans took control of both houses of Congress and leaders of both parties decided they had better find a way to get something positive accomplished, the atmosphere for permanently repealing SGR and replacing it with a more sensible payment system seemed to brighten. And, with the pressure on because of the impending April 1 date when those huge cuts would be implemented, House and Senate leaders decided it was time to act.

FROM THE AACU - Urology's advocacy priorities: One down, four to go

In 2015, AUA members sent nearly 1,400 letters to members of Congress, including 92 of the 100 senators, urging repeal of the SGR. They participated in more than 200 meetings on Capitol Hill as well, and they worked within broader coalitions to keep the heat on Congress.

So, when MACRA was finally passed, the AUA breathed a huge sigh of relief.

“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. 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,” said AUA President William W. Bohnert, MD.

MACRA also drew praise from LUGPA and the American Association of Clinical Urologists 

NEXT: MACRA stabilizes fee updates


MACRA stabilizes fee updates

In a policy brief, the AUA pointed out that in addition to repealing the SGR, MACRA stabilizes fee updates for physicians, including annual positive updates of 0.5% through 2019, when the SGR will be replaced with a streamlined Merit-Based Incentive Payment System that will focus the fee-for-service model on providing value and quality.

In addition, MACRA eliminates current penalties from the existing quality programs, such as the Physician Quality Reporting System, Electronic Health Record Meaningful Use Program, and the value-based modifier program.

READ: Congress cuts coverage for erection devices

The new law also contains several other key provisions of interest to urology, including language to reverse the decision by the Centers for Medicare & Medicaid Services to eliminate bundling of 10- and 90-day global payments for surgical services. It also mandates that EHRs are fully interoperable by 2018 and requires the Government Accountability Office to report to Congress on barriers to expanded use of telemedicine and remote patient monitoring.

Now that the law has been passed, the AUA says it will focus on the implementation phase of the new Medicare payment system, including new programs and rules as the government begins the process of implementation.

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Pressure continued on Capitol Hill to find ways to cover the $141 billion in costs not covered by the law. However, there were reliable reports that while budget negotiators planned to include payment offsets in the budget resolution currently being developed, those offsets would be implemented some time in the future.

That, of course, will be an important development to watch carefully as those offsets could also have a significant impact on urologists.

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