Congress stalls Medicare doc payment cuts

The U.S. House of Representatives passed legislation Thursday that will delay for three months major cuts to physicians' Medicare payments scheduled for next year, according to MedPageToday. The bill is expected to reach the Senate floor sometime next week.

Both houses of Congress are also at work on bills that would permanently repeal the sustainable growth rate (SGR) payment formula, and votes on the bills are possible in early 2014, according to the article. In addition to repealing the SGR, the bills, which have already passed the House Ways and Means Committee and the Senate Finance Committee, respectively, would:

  • Increase payments by 0.5 percent through 2017 and flat payments through 2023;

  • Mandate "appropriate use criteria for advanced diagnostic imaging;"

  • Simplify current payment incentive programs by combining them into one value-based program;

  • Increase the public availability of provider payment data;

  • Give physicians who privately contract with Medicare patients the option to automatically renew their two-year opt out;

  • Provide 5 percent bonuses for doctors who use a qualifying alternative payment model; and

  • Give electronic health record vendors until 2017 to make their EHRs interoperable.

The legislation is "much more than a fix," said Rep. Sandy Levin (D-Mich.), the ranking Democrat on the House Ways and Means Committee, according to the article. "This is an effort to create a new framework for physician payments in Medicare."

While industry groups have long urged Congress to repeal the SGR, there is not enough time remaining in the year to pass the legislation, hence the three-month patch to stall the cuts due to take effect in January, according to the article. The patch was part of a larger bipartisan deal reached earlier this week.

Physician advocacy groups are optimistic that the fix will buy time to pass the bills permanently and repeal the payment formula, according to MedPageToday.

"This long-overdue policy change provides the stability that physicians need to pursue delivery innovations that help improve patient care and reduce costs for American taxpayers," American Medical Association President Ardis Dee Hoven, M.D., said in a statement.

Neither permanent repeal bill specifies how to fund the repeal, according to the article. A September report from the Congressional Budget Office (CBO) estimated the cost of repeal at $175 billion, FierceHealthcare previously reported.

To learn more:
- here's the article
- read the AMA statement