SENATE SENDS SHORT-TERM SGR FIX TO PRESIDENT’S DESK:On Monday, the United States Senate voted 64-35 in favor of delaying cuts to Medicare physician reimbursements for one year as a result of the sustainable growth rate (SGR) formula. The bill, Protecting Access to Medicare Act of 2014, is identical to H.R. 4302 passed in the House of Representatives last week, was signed into law by the President. The bill received heavy criticism from physician groups as it allows the Centers for Medicare and Medicaid (CMS) to identify misvalued codes used under the Medicare Physician Fee Schedule. This provision is expected to cut $5 billion from the physician fee schedule over three years beginning in 2017 and will be used to partially offset the cost of the yearlong patch.
WHAT’S IN THE BILL: The short-term fix prevents the scheduled 24 percent cuts to physician’s Medicare reimbursements on April 1 and contains a positive 0.5 percent update for physicians through December 2014. Then, beginning in January 2015, physicians will receive a 0.0 percent update until the end of March 2015 when the patch will yet again expire. While the majority of medical groups had opposed this legislation, physicians earned a one-year delay of ICD-10 implementation, which was previously set to take effect this October. Other provisions in the bill include:
- establishing a program for appropriate use criteria on certain imaging services;
- delaying “two-midnight” rule for inpatient reimbursements through June 2015;
- delaying recovery audits (RAC) on unnecessary claims through March 2015.
OUTLOOK DOES NOT FAVOR REPEAL THIS YEAR: Despite the recent vote, leaders in the House and Senate said that passage of a short-term SGR fix doesn’t preclude Congress from passing full repeal and replacing legislation before the end of the year. However, considering the proximity to this November’s mid-term elections, and the traditionally inactive lame duck season that follows, the prospects of repealing the SGR this year are very slim. NASS will continue to urge members of Congress to work together to pass the previously agreed upon bi-partisan, bi-cameral SGR repeal legislation as the negotiations over offsets continue.