With SGR repeal, Medicare refocuses on value

Enactment of the law also looked a bit shaky when the Office of the Actuary for the Centers for Medicare & Medicaid Services released a report April 9 that suggested physicians would see future payment cuts under the law.

“Physician payment rates under H.R. 2 would be lower than scheduled under the current SGR formula by 2048 and would continue to worsen thereafter,” according to the report. “Absent a change in the method or level of update by subsequent legislation, we expect access to Medicare-participating physicians to become a significant issue in the long term under H.R. 2.”

However, the AMA’s Dr. Madara said that he was not concerned about the projections because the report assumes no changes in coming years. “One does not make linear trajectories over a periods of decades or more and assume that that’s where we are going to end up because that assumption is that nothing happens in the interim and, as we all know, that’s just simply not the way life works,” he said.

AMA President Robert Wah noted that the report “fails to take into account the long-range impact such a drastic payment cut [due to the SGR] would have on quality and access for Medicare beneficiaries, or the many options H.R. 2 will make available to physicians for avoiding onerous penalties under current law and the significant positive updates that high performers can earn.”

The American College of Physicians applauded the Senate action.

“We all witnessed something quite extraordinary and historic today when the Senate followed the House in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate formula (H.R. 2) and transition us to a new value-based system,” ACP President David Flemming said in a statement.

American Society of Clinical Oncology President Peter Paul Yu said in a statement that “Medicare beneficiaries and their physicians can breathe easier knowing they will no longer face the perennial threat of payment cuts that risk disruption of care and cause anxiety among patients. ... [ASCO] looks forward to working with policymakers to ensure that this new law is effectively implemented and paves the way to new payment models that foster high-quality, value-based health care for all Americans with cancer.”

Similarly, the American Society for Radiation Oncology praised the effort. “Permanently repealing the SGR and replacing it with a stabilized reimbursement plan focused on quality will strengthen Medicare and allow us to enhance cancer care for the more than one million patients treated with radiation therapy each year,” Dr. Bruce G. Haffty, chair of ASTRO’s board of directors, said in a statement.

American College of Cardiology President Kim Allan Williams Sr., in a statement applauding the actions of the Senate, noted that the members “accomplished a major feat by passing legislation that ends a cycle of delays and patches in the law, which created uncertainty for Medicare patients and clinicians for more than an decade.”

The American College of Surgeons lauded the Senate action.

“The reforms set in place by Tuesday’s historic Senate passage of H.R. 2 offers peace of mind to America’s seniors, whose access to medical care through the Medicare program has been threatened for more than 10 years,” Dr. David B. Hoyt, executive director of the American College of Surgeons, said in a statement. “The College is committed to working with policymakers to further develop policies authorized in the legislation that stress quality of care for Medicare beneficiaries.”

The American Psychiatric Association praised the work of the Senate to pass the bill. “The Senate passage of the SGR reform bill is a major step toward a reliable and rational payment system for Medicare beneficiaries and their physicians,” APA President Paul Summergrad said in a statement. “It is long overdue.”

“It is time for a health care system in America that is focused on delivery of quality care, rather than quantity of care,” Dr. John C. Jennings, president of the American Congress of Obstetricians and Gynecologists, said in a statement. “By strengthening the ability of providers to focus on prevention, this bill will help to ensure that more Americans are able to stay healthy, avoiding serious illnesses and their related costs.”

The American College of Emergency Physicians called the move away from the SGR and toward a value-based system “essential to emergency departments. Elderly patients are more likely to need emergency care than any other age group, and the fastest growing segment of the U.S. population is people over 85 years of age. It represents a significant accomplishment for all the emergency physicians who actively made their voices heard in Congress.”