SGR REFORM IN THE CROSSHAIRS OF BUDGET DISCUSSIONS: Efforts to repeal and replace the flawed sustainable growth rate (SGR) formula were put on hold while Congress worked to pull together a funding capitol webdeal and a temporary extension of the US debt limit. While Congressional leaders suggest that SGR replacement legislation is still on the table as part of a larger budget deal, NASS is concerned that a deal will not be reached, and Congress will punt the issue until next year. Should Congress be unable to pass full SGR repeal legislation this year, physicians will again face the prospect of major cuts to reimbursements. This year, however, is different than years past as there is no short-term strategy in place to prevent the expected 24.4% cuts to Medicare reimbursements for physicians. Typically Congress will pass short-term patches via end-of-the-year budget deals, however, in the latest deal to re-open the government, Congress extended funding for government agencies through January 15, 2014, two weeks after the cuts to Medicare are set to kick in.

IN THE MEANTIME: Since Energy and Commerce has passed its own SGR replacement bill, the House Ways and Means and Senate Finance Committees have continued working behind the scenes on their iterations of SGR repeal and replace. Sources inform NASS that the Senate Finance Committee has sent portions of its proposal to the Congressional Budget Office (CBO) for a score, and contains zero offsets, as the committee wants to score the SGR policy before getting into what will surely become a divisive issue.

AND IN THE HOUSE: Ways and Means committee members have indicated that their bill will also likely contain zero payfors and the Committee is attempting to keep the bill’s price-tag closer to $140 billion, which is the clean cost of repealing the SGR over 10 years. Committee leaders have said that they are struggling to convince younger members of the Republican caucus to pass an SGR bill as a result of the costs associated with offsetting repeal.

HOUSE AND SENATE LEADERS ANNOUNCE CONFEREES: The recent deal reached between the House and Senate to re-open the government set the course for budget negotiations to begin between the two chambers. The leaders of the Senate and House Budget Committees, Senator Patty Murray (D-WA) and Representative Paul Ryan (R-WI), along with selected conferees, have already begun developing a framework for negotiations and have a “non-binding” date of December 13, 2013 to reach an agreement. Earlier in the year, both leaders released their respective budget proposals, which are now being used as the basis for the new negotiations. Providers groups have expressed concern that the talks open up “the whole menu of options for healthcare reductions—including payments to critical-access hospitals, graduate medical education, the Medicaid provider tax, coding offsets and hospital bad debt.”

DEVICE TAX STILL IN THE MIX: The medical device industry has said that it will continue to press Congress to repeal the Affordable Care Act’s 2 percent device tax. Repeal of the device tax was touted as a possible compromise by Senator Susan Collins (R-ME) during the shutdown conversations, and while repeal has immense bipartisan support in the House and Senate, it was eventually not included in the final deal.