Congressional Push for Lame Duck Medicare SGR Repeal

With only a short time remaining before Congress adjourns for the year, there is considerable support for repealing the Medicare Sustainable Growth Rate (SGR) physician payment formula before the end of the 113th Congress.

Although the current SGR patch (P.L. 113-93) will prevent Medicare cuts to doctors through March 2015, the desire to harness the progress made during the current Congress, upcoming retirements and the short time window for action next year are all contributing to the push to dispose of the SGR before the end of the year.

Last month, the GOP Doctors Caucus sent a letter to House leadership urging that all possible efforts be made to reach an agreement that will allow H.R. 4015/S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act, to be signed into law before the end of the year.

While there is consensus that the payment formula is broken and in need of replacement, there remain several obstacles to action on the SGR in the lame duck session. There is lack of agreement among lawmakers on how to pay for permanently replacing the SGR formula, even though they have reached a bipartisan, bicameral compromise on the policy. This impasse is further complicated by the few remaining days on the congressional calendar in the lame duck. Congress is expected to complete work on Friday, December 12, 2014 but Senate Majority Leader Harry Reid (D-Nev.) has already suggested the possibility of staying in later.

The latest cost estimate by the Congressional Budget Office (CBO) released on November 14, 2014, estimated that the bipartisan, bicameral "doc fix" plan introduced in February (H.R. 4015, S. 2000) to replace the SGR would cost $144 billion over a decade (fiscal years 2015 to 2024). That is an increase from the roughly $138 billion, 11-year price tag that CBO released in February 2014.

ASPS has not fully supported this SGR replacement bill due to concerns about penalty and quality provisions contained in the legislation. ASPS continues to advocate on behalf of its members that any SGR bill include incentives to develop more clinically relevant quality measures and recognition of more flexible and meaningful reporting options, including clinical data registries. ASPS also supports provisions to assure that data reported as a part of a quality reporting system would not be used to establish standards of care or otherwise give rise to a medical liability cause of action.