With bipartisan efforts stalled for a permanent repeal of the sustainable growth rate (SGR) formula, two committees in the U.S. House of Representatives have introduced yet another patch that would avert cuts to Medicare reimbursement mandated by the SGR.
The House Committee on Energy and Commerce and the Committee on Ways and Means have introduced a bill that would prevent a 24% cut in payments to doctors set to go into effect April 1, replacing it with a 0.5% increase in payments through December of this year and a 0% update from January 1 to April 1, 2015.
Cuts in Medicare payments are required under the SGR formula, which links Medicare reimbursement rates with increases in the country's gross domestic product. The SGR has mandated cuts every year since 2002, but each year Congress passed legislation delaying its implementation. This latest fix would be paid for by $2.3 billion set aside for the SGR in the Bipartisan Budget Act of 2013 and a shift in the Medicare sequestration timeline in fiscal-year 2024, according to the two committees.
The bill, called the Protecting Access to Medicare Act of 2014, would mandate that cuts to medical services greater than 20% -- compared with the previous year -- be phased in over two years, noted the American College of Radiology (ACR). The legislation would also delay implementation of the ICD-10 provider payment codes for one year.
The legislation would require the U.S. Centers for Medicare and Medicaid Services (CMS) to produce data used to justify a 25% multiple procedure payment reduction (MPPR), instituted in 2012, for certain imaging procedures provided to the same patient, on the same day, in the same session, ACR said.
Finally, the bill includes quality incentives for diagnostic imaging and evidence-based care, specifically establishing CT equipment radiation dose standards for payment under the Medicare program and appropriate use criteria for imaging services, according to Cynthia Moran, ACR's assistant executive director for government relations.
"This bill is a mixed bag for us," Moran told AuntMinnie.com. "It includes the appropriateness criteria policy and MPPR transparency. But it also gives the [U.S. Department of Health and Human Services] secretary huge new powers regarding 'misvalued services' to go into practically any physician payment made by Medicare and re-evaluate it -- through which the House expects to save $5 billion."
The House is expected to consider the bill on March 27, followed shortly thereafter by the Senate.
