US Senate Passes “Doc Fix” – SGR Finally Repealed

After weeks of uncertainty, the U.S. Senate passed H.R. 2, the “Medicare and CHIP Reauthorization Act” (MACRA),  last night with an overwhelming majority vote of 92-8. The House passed H.R. 2 last month, in an unprecedented bipartisan vote  of 392-37. The bill now moves to the White House for President Obama’s signature.

H.R. 2 finally repeals the flawed SGR formula for physician reimbursement, first introduced in 1997 as part of the Balanced Budget Amendment. It has been patched 17 times since 2003; an AMA estimate places the cost of these patches at $153.7 billion.

Key Bill Features

• The sustainable growth rate (SGR) is permanently repealed, effective immediately.
• Positive payment updates of 0.5 percent are provided for four and a half years, through 2019.
• Physicians in alternative payment models (APMs) receive a 5 percent bonus from 2019 to 2024.
• In 2026 and beyond, physicians in APMs qualify for a 0.75 percent update; all others will receive a 0.25 percent annual update.
• The fee-for-service payment model is retained, and physician participation in APMs is entirely voluntary.
• Technical support is provided for smaller practices, funded at $20 million per year from 2016 to 2020, to help them participate in APMs or the new fee-for-service incentive program.
• Funding is provided for quality measure development, at $15 million per year from 2015 to 2019. Physicians retain their preeminent role in developing quality standards.
• Current quality incentive and payment programs are consolidated and streamlined, and the aggregate level of financial risk to practices from penalties has been mitigated in comparison to current law.

CSMS members can find additional details in the upcoming Weekly E-News, as well as other CSMS publications.

Additional Reading

“Doc fix” heads to President’s desk after easily clearing Senate – Modern Healthcare

FAQ: Congress passes a bill to fix Medicare’s doctor payments. What’s in it? – Kaiser Health News

 

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