Ways and Means, Senate Finance Committee Expected to Act on SGR

Since the Energy and Commerce committee passed its sustainable growth rate (SGR) bill by a sweeping 51-0 vote in late July, attention is now focused on how the other committees of jurisdiction, mainly the capitol webHouse Ways and Means and Senate Finance committees, will follow. Congressional sources say that Ways and Means staff has developed a framework that is similar in principle to the Energy and Commerce bill. However, it will contain some differences and may contain payfor provisions that would be used to cover the cost of repealing and replacing the SGR. Ways and Means staff met with staff members of the Senate Finance committee to discuss their framework before last August, and the two are expected to meet again later this month.

However, Democratic sources have informed NASS that leaders of the Senate Finance committee were not particularly pleased with the Energy and Commerce bill, as Democrats on the committee have been partial to eliminating fee-for-service (FFS) as a payment option for physicians (Energy and Commerce bill contains a modified FFS program) and are opposed to a five-year freeze with payment updates. As a result, NASS expects that the Finance committee bill will not mirror the Energy and Commerce bill.

It is also unclear at this time whether the Senate Finance SGR bill will contain any payfors. Sources inform NASS that the Ways and Means committee will introduce and mark-up its bill in late October, and Senate Finance will introduce a bill sometime in early November. The timing of the committee’s release of an SGR alternative is causing some unease among members of Congress and staff, as Congress has yet to pass a short-term continuing resolution (CR), and expect that the SGR will be sidelined as Congress prepares for a debt-limit debate that will take place around the same time.

NASS and the Alliance of Specialty Medicine have continued to conduct several meetings with staff members of the two committees and will continue to press Congress to repeal this SGR this year and reiterate its principles for a replacement.

In Case You Missed It: CBO Issues Cost Estimate for Medicare Physician Payment Reform

The Congressional Budget Office (CBO) released its estimate of the cost effects of H.R. 2810, legislation passed by the House Energy and Commerce Committee which would eliminate the (SGR) and replace it with one based on health care quality. CBO said the reform would result in an additional cost of $175 billion over the 10-year period 2014-2023. The scheduled cut in physician payments of about 24% beginning January 1, 2014 would be replaced by an increase of 0.5% for 2014 through 2018 (five years). The initial CBO score of $138 billion was based on the cost of repealing the SGR with a 10-year freeze, thus the new number reflects the costs associated with updates and accounts for the utilization of alternative payment models, which assumes physicians would establish and then choose those models that would offer greater rewards. It is unclear whether the Ways and Means committee or Senate Finance committee bills will score the same. Click here to view CBO’s estimate.

PCORI Announces New Grants

The Patient-Centered Outcomes Research Institute (PCORI) announced that the agency is on track to grant over $114 million for 71 new comparative effectiveness research (CER) projects which are to include studies of ways to improve care for a multitude of health conditions, including chronic pain.