KEY HOUSE AND SENATE COMMITTEES POISED TO MARK-UP SGR PROPOSAL
The Senate Finance committee announced that it would hold a mark-up hearing on a revised bi-partisan, bi-cameral proposal that permanently repeals the sustainable growth rate (SGR) this week capitol webbefore Congress breaks for its end-of-the year recess. The House Ways and Means committee is also expected to mark-up a similar proposal this week. However, a formal notice has yet to be released by the committee. The hearings come on the heels of a stakeholder meeting that the committees jointly hosted last week to discuss changes made as a result of stakeholder feedback. In keeping with tradition, the Senate Finance committee will be marking-up “conceptual” legislation and is the first time the committee will have marked-up health related legislation in five years. The Ways and Means committee has released actual legislative text and summary of the proposal. It remains unclear if the Ways and Means committee will offer an open amendment process during the make-up, though it’s unlikely. Conversely, the Senate Finance committee is expected to have an open amendment process.

DESPITE CHANGES, CONCERNS STILL PREVALENT IN SGR PROPOSAL
While many of the recommendations from NASS and the Alliance of Specialty Medicine were incorperated into the revised Senate Finance and Ways and Means SGR proposal, NASS is still concerned that certain provisions within the proposal will have unintended consequences on patient access to spine care providers. Among these concerns are:

  • Payments to physicians will be frozen — Ways and Means bill provides 0.5 percent update for years 2014–2016 and then zero percent for years 2017-2023, Senate Finance implements a 10-year update freeze for years 2014–2023.
  • no assurances of a viable fee-for-service system;
  • neglecting to include at least a five-year transition period to a new payment system; and
  • creating a new budget-neutral, tiered quality payment program that measure an individual’s performance relative to others, instead of recognizing personal achievement or the attainment of certain thresholds regardless of how others perform is not only unfair, but ultimately will      ensure that physicians become competitors, rather than collaborators, on quality improvement.

NASS and the Alliance of Specialty Medicine are currently formulating a response to the respective Committees to address these concerns.



SGR PATCH LIKELY CONSIDERED THIS WEEK

Despite efforts this year to repeal the SGR, Congress appears poised to pass legislation by the end of this week that will temporarily patch the projected 24% cuts to physician’s Medicare reimbursements. According to budget sources, the SGR patch will last 90 days and contains a 0.5 percent update for providers through April 1, 2014. Leaders have opted for a short-term patch, forcing Congress’ hand in passing SGR legislation early next year — and at that point could be attached to a larger budget deal.

CBO LOWERS SGR REPEAL SCORE
To the surprise of many, the Congressional Budgeting Office (CBO) released a lower projection late last week of the 10-year cost to repeal the SGR. According to CBO estimates, the new cost of repealing the SGR is $116 billion, $20 billion less than its previous estimate from earlier this year. The Energy and Commerce Committee wasted little time to tout the $20 billion difference, which drops the cost of its SGR bill to $150 billion.

CMS DELAYS MEANINGFUL USE PROGRAM
The Centers for Medicare and Medicaid Services (CMS) announced last week that it will delay its phased roll-out of the EHR Incentive Program, with Stage 2 now starting in 2015 and continuing through 2016, and Stage 3 beginning in 2017 for providers that have completed two or more years at that lower level. The goal is to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2, and to utilize data from Stage 2 participation to inform policy decisions for Stage 3. CMS expects to issue a proposed rule for Stage 3 in fall 2014 and to outline details of the new timeline. The final rule would follow in the first half of 2015. More information on this announcement is available here.

FDA RELEASES GUIDANCE ON DRUG COMPOUNDING LAW

With the President’s action to sign into law the Drug Quality and Security Act (DQSA), the Food and Drug Administration (FDA) released implementation guidance, including: the creation of a new category of compounding facilities (ie, outsourcing facilities); guidance on how such outsourcing facilities should implement drug reporting requirements; and guidance on the process for registering such facilities, including the payment of fees by September 30, 2014. The FDA plans to provide guidance on the Act’s track-and-trace drug supply provisions in stages.