Hurry Up and Wait: Senate Says “Not So Fast” to the Sustainable Growth Rate Bill


Hurry Up and Wait: Senate Says “Not So Fast” to the Sustainable Growth Rate Bill


It’s not happening. Not yet anyway.

After yesterday’s passage by the U.S. House of a bill eliminating the sustainable growth rate (“SGR”) formula - otherwise known as the “doc fix,” the Senate leaders decided they’d rather think about the bill after Spring Break. As for the March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut, CMS is going to slow-play claims processing to delay the actual implementation of the cut. Earlier this week, President Obama indicated that he would sign the House measure, and the American Hospital Association also came out in support of the bill in this letter. Senate majority Leader Mitch McConnell stated that the Senate would take up the issue when Congress reconvenes in mid-April. According to Reuters, McConnell said "I think there's every reason to believe it's going to pass the Senate by a very large majority.”

For our physician clients, the SGR formula and the ongoing measures to prevent it from going into effect have created an unstable environment for many years.  The legislation would provide physicians an annual 0.5% bump for the next several years as Medicare transitions to a payment system designed to reward physicians based on the quality of care provided, rather than on the quantity of procedures performed, as the current payment formula does. Then, most doctors would see an annual 0.25% payment increase.

There are a number of additional, relevant provisions in the bill aside from eliminating the SGR, such as CHIP and telehealth —  all of which aim to support greater value and physicians who are willing to do their part to help achieve greater value for their patients.

And for patients, if the scheduled 21 percent SGR cut were to go into effect on April 1 as scheduled, many physicians would no longer be able to afford to see Medicare patients.  Even with the temporary SGR overrides, Medicare payments have not kept pace with inflation for at least 13 years now — which in itself has caused some physicians to reassess their participation in the program.   

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