CBO SCORES LATEST SGR COMPROMISE BILL: The Congressional Budget Office (CBO) sent a letter to newly appointed Senate Finance Committee Chairman Ron Wyden (D-OR) last week with capitol webthe agency’s 11-year cost estimate of the latest sustainable growth rate (SGR) replacement legislation. It’s not clear exactly why the CBO scored the bill over an 11-year period, since the agency is known to typically score bills over a 10-year period. However, the CBO set their cost estimate at around $138 billion. The estimate does not account for Medicare “extenders” policies (around $30 billion), which had been a sticking point for Senate Democrats during the negotiations before agreeing to sign-off on the latest deal. A significant portion of the cost of the bill is a result of the inclusion of a provision that provides a  0.5 percent update for physicians over five years.

DOCTORS CAUCUS SIGNS-OFF ON SGR LEGISLATON: Just as the CBO was releasing their new numbers on the SGR replacement policy, the House Republican Doctors Caucus was meeting to galvanize unanimous agreement to support the SGR bill from its members. A few members of the caucus had not pledged their support for the bill, sighting lack of identifiable offsets and concerns with the duration of the period of stability. The Doctors Caucus letter was sent to House leaders of both political parties, and is being heralded as a major achievement in the progress toward reforming Medicare’s physicians pay formula.

PASSAGE OF SGR REPLACEMENT BILL STILL DOUBTFUL AMID PAYFOR DEBATE: As the stars continue to align in the hopes that Congress will send a bill to the President’s desk this year to once-and-for-all replace the SGR, one major hurdle that Congress will need to come to grips with is settling the SGR payfor question.

Lawmakers of all stripes say that potential cuts to providers to fund any aspect of replacing the SGR are simply unsustainable. However, some groups continue to press lawmakers to close physician self-referral “loopholes,” otherwise known as the Stark Law’s In-Office Ancillary Services Exemption (IOASE), to partially offset the cost of the SGR.

NASS has and continues to be strongly opposed to removing physician referral exemptions and is working within a coalition of specialty societies to address this issue. NASS’ support for the recent bi-partisan, bi-cameral SGR legislation is contingent on Congress identifying suitable offsets that do not jeopardize spine care providers, their practices and their patients’ access to high-quality care. Last year, in a show of solidarity, four former physician practitioners of the US Senate sent a letter to Senate leadership expressing their support for preserving the Stark Law exemptions.  NASS will continue to provide updates as they become available.

CONGRESSMEN INTRODUCE LIABILTY PROTECTION LEGISATION: On Feb. 27, Representatives Andy Barr (R-KY) and Ami Bera, MD (D-CA) introduced the Safe Harbors Act of 2014.  This legislation provides medical professionals subject to a medical malpractice lawsuit the option of review by an independent medical review panel in cases where the adherence to applicable clinical practice guidelines will be used as an affirmative defense. Medical professionals can use their adherence to clinical guidelines to protect them and cannot be held liable solely for nonconformity with guidelines. NASS is currently reviewing the merits of this legislation for support. More information about the bill will be available here.