SGR Repeal Legislation Passes Senate; Obama Expected to Sign ASAP

2015-04-15 | , American Association of Orthopaedic Surgeons

Last night, the Senate passed the Medicare and CHIP Reauthorization Act (H.R. 2) by an overwhelming vote of 92 to 8. This much-needed legislation permanently repeals the Sustainable Growth Rate (SGR) formula, ensuring the highest quality of care for Medicare patients and ending the threat of substantial payment cuts in physicians’ Medicare reimbursement. The House passed the legislation last month, which means the bill now goes to President Obama, who has said he will sign it.

“The AAOS commends the Senate for passing a permanent repeal and replacement of the flawed SGR formula,” stated David D. Teuscher, MD, President of AAOS. “On behalf of the more than 38,000 AAOS members, we thank Congress for the tremendous bipartisan effort put into SGR reform and congratulate legislators for enacting a bill that implements meaningful reforms to the Medicare program. I urge President Obama to sign this bill today and prevent the 21 percent cut to physician reimbursement.”

H.R. 2 included a number of important provisions. In addition to permanently repealing the SGR formula, the legislation institutes a 0.5 percent payment update each year for five years. The 0.5 percent payment update is significantly better for physicians than the 10-year payment freeze that was part of an earlier draft last year, which AAOS and other physician groups strongly opposed. The legislation also expands availability of Medicare data by allowing qualified clinical data registries to purchase claims data for purposes of quality improvement and patient safety. Further, the bill protects providers from having quality metrics used against them in medical malpractice suits by clarifying that development of any quality or clinical guideline in Medicare or through other laws cannot be construed to establish a standard of care or duty of care. The AAOS fought hard for this and it is a welcome provision.

Global Payments

Additionally, H.R. 2 reverses the harmful global payments policy that was announced in the 2015 Physician Fee Schedule (PFS) Final Rule by the Centers for Medicare and Medicaid Services (CMS). In the 2015 PFS Final Rule, released October 31, 2014, CMS confirmed its intention to convert all 10- and 90-day global procedure codes to 0-day global codes (read more about the global payments issue in AAOS now here). AAOS aggressively lobbied Congress to take whatever steps necessary to reverse this decision.

“Because this policy will have a wide-ranging negative impact on patients, physicians, hospitals, third-party payers, and CMS, we recommend that Congress take the necessary steps to prevent CMS from implementing this policy,” the AAOS wrote in a December 2014 letter to Congress.

The AAOS applauds Congress for following this recommendation and addressing the important global payments issue in H.R. 2.

Quality Improvement Programs

This legislation also replaces the existing Physician Quality Reporting System (PQRS), Value-Based Modifier, and Meaningful Use of Electronic Health Records (EHR) programs with a new, single Merit-Based Incentive Payment System (MIPS) program. The new program will remove many of the reporting burdens faced by physicians and will be based on performance measures selected by each physician from a menu of performance measures created by specialty-specific associations. Further, the bill promotes collaboration by allowing professional organizations, physicians, and other relevant stakeholders to identify and submit quality measures and updates to be considered for selection and used in the performance program.

For more on the provisions in the SGR, see this earlier Advocacy Now article.

Your Efforts

“The SGR has plagued the health care industry for over a decade,” continued Dr. Teuscher. “AAOS has consistently called for the permanent repeal of the SGR, and orthopaedic surgeons around the country have emailed, called, and visited their members of Congress, urging legislators to understand the importance of repealing the SGR for good. That effort helped achieve today’s result. Again, we thank legislators for their work to enact H.R. 2, and we look forward to continued input as the quality metrics and other regulations surrounding this bill are developed.”

For example, in February, orthopaedists and other medical specialists held more than 50 different in-person meetings on Capitol Hill. Joining the AAOS leadership in Washington were representatives from the American College of Surgeons, the American Academy of Ophthalmology, the American Urological Association, and the American Congress of Obstetricians and Gynecologists. AAOS members also participated via email and social media together with the American Academy of Otolaryngology-Head and Neck Surgery, American Association of Neurological Surgeons, American College of Cardiology, American Society of Hand Therapy, American Association of Orthopaedic Executives, and the North American Spine Society. More than 780 emails were sent to members of Congress through the AAOS Legislative Action Center and approximately 350 tweets were posted on Twitter from approximately 100 different users. The postings reached more than 134,000 unique individuals and were seen more than 900,000 times.

“This bill ensures Medicare’s solvency and improves care delivery, while ending the reckless system of short-term patches that has been harmful to the economy and to Medicare patients seeking access to specialties they desperately need,” stated Thomas C. Barber, MD, Chair of the AAOS Council on Advocacy. “The AAOS has worked closely with congressional and committee leadership to ensure the legislation provides the highest quality of care for Medicare patients, reduces reporting and other administrative burdens, adds needed flexibility for physicians, and allows for medical specialty input in development of quality measures. We thank Congress for their hard work and continued dedication to finding a viable solution to the flawed formula.”