The U.S. Congress has reached a bipartisan agreement that permanently repeals the flawed sustainable growth rate (SGR) mechanism.
The deal would avert a 23.7% SGR-induced cut scheduled for April 1, 2014, and it ensures that physicians will receive a pay increase of 0.5% over the next five years, according to a statement released by the House Energy and Commerce Committee.
The legislation is the culmination of efforts to fix the SGR formula by the Energy and Commerce Committee, the House Committee on Ways and Means, and the Senate Finance Committee.
Under the legislation, physicians will receive an annual update of 0.5% from 2014 through 2018. Payment rates in 2018 will be maintained through 2023, while providing physicians with the opportunity to receive additional payment adjustments through an incentive payment program called the Merit-Based Incentive Payment System (MIPS).
In 2024 and subsequent years, doctors participating in alternative payment models that meet certain criteria would receive annual updates of 1%, while all other doctors would receive annual updates of 0.5%, according to the bill's text.
In addition, beginning with the 2015 fee schedule, there is a provision that would implement a two-year phase in for any payment cuts of 20% or more -- an idea introduced by the American College of Radiology (ACR).
"We introduced this concept of 'dampening' to prevent the Centers for Medicare and Medicaid Services [CMS] from reducing payments for any procedure by more than 12.5% in a 12-month period," Cynthia Moran, assistant executive director for government relations at the ACR, told AuntMinnie.com. "This bill doesn't give us exactly what we wanted, but it validates the concept."
The legislation also includes a mandate that CMS must reveal the data and analysis it used to determine the 25% multiple procedure payment reduction (MPPR) policy for the professional component of diagnostic imaging, Moran said.
The bill does not outline how the SGR repeal will be paid for; the cost is estimated at $128 billion over the next 10 years, according to Moran.
"The biggest hang-up now is how to pay for this," she said. "There's no consensus on that as of yet. But as the physician community and Congress have never come so close to finally correcting the SGR, this is an extremely positive development."
