Proposal to eliminate SGR payment formula is revised

Apr 5 2013

The House panels' proposal to replace Medicare's sustainable growth rate formula is seen as a way to change how Medicare delivers care. Meanwhile, some House GOP lawmakers who have complained about the health law's costs said Wednesday that it should have allocated more money to a program to cover people with pre-existing health conditions.

Modern Healthcare: House GOP Releases Revised Proposal For Replacing SGR
House Republican leaders released a revised proposal to replace Medicare's sustainable growth-rate physician payment formula. The proposed system would include specialty-specific performance measures, payment rates partly based on patient experience, and development of an appeals process to contest or reconsider a provider's quality score. Chairmen of the House Energy and Commerce and Ways and Means committees along with their respective health subcommittees issued the revised proposal on April 3 with a letter to the "provider community" (PDF) requesting comments on the new draft by April 15 (Robeznieks, 4/3).

The Hill: House Panels Release New Outline For Permanent 'Doc Fix'
Leaders of two top House committees are circulating an expanded draft of their plan to repeal Medicare's sustainable growth rate (SGR), the flawed physician payment formula that necessitates an annual "doc fix." The plan from the Energy and Commerce and Ways and Means panels would use SGR repeal as an opportunity to make dramatic changes to healthcare delivery within Medicare (Viebeck, 4/3).

Kaiser Health News: Capsules: GOP Members Call For Increased Spending To Cover Pre-Existing Conditions
Republicans who have spent the past three years blasting the health care overhaul as an overreach by the federal government said Wednesday the law didn't allocate nearly enough money for a temporary program offering insurance coverage to those with pre-existing conditions (Galewitz, 4/3).

Medpage Today: $$$ For Pre-existing Conditions Pain ACA
The high cost of covering adults with preexisting conditions before 2014 could signal greater costs for all individuals within the broader health insurance market, a health economist warned lawmakers. The Pre-Existing Condition Insurance Plan (PCIP), which the Affordable Care Act (ACA) created as a way to provide health coverage to those with preexisting medical conditions before other aspects of the law take effect in 2014, does nothing to reduce the costs of care for those patients, Thomas Miller, JD, resident fellow at the conservative American Enterprise Institute here, said at a congressional hearing Wednesday. Despite garnering only 110,000 enrollees -- far less than the 375,000 expected -- the PCIP program has run out of the $5 billion Congress gave it (Pittman, 4/3).

In other Capitol Hill action, Rep. Diane Black, R-Tenn., introduced legislation to give some physicians nearing retirement a break regarding electronic health record adoption penalities -

Medscape: Bill Would Exempt Retirement-Age Physicians From EHR Penalty
Physicians near retirement wouldn't suffer a Medicare pay cut for failing to adopt an electronic health record (EHRs) system, and soloists would get a 3-year hiatus from this penalty under a bill introduced last month by Rep. Diane Black (R-TN). The measure, which Black had introduced in the previous session of Congress, also would give specialists some breaks in earning bonuses and avoiding penalties in the incentive program, designed to promote "meaningful use" of EHRs for the sake of improved patient care and lower costs (Lowes, 4/3).