Tag Archives: SGR

Change to Medicare will shift physicians into value-based payment

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President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on Thursday afternoon, in what experts say could be the most significant change in Medicare’s 50-year history.

The law, part of a bipartisan deal to eliminate the Sustainable Growth Rate (SGR) formula that Congress had used to set physician payment rates under Medicare, shifts the 50-year-old program away from a fee-for-service model and moves physicians into value-based payment.

Earlier this week the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 by a vote of 92 to 8. Last month, the House passed its version of the bill by 392-37. Continue reading →

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

As it considers SGR fix, Senate weighs fundamental shifts to Medicare

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Image by 401(K) 2012 via Flickr

Image by 401(K) 2012 via Flickr

After voting to eliminate the Sustainable Growth Rate (SGR) formula last week, the U.S. House of Representatives sent the measure to the U.S. Senate where the bill’s fate is uncertain. When the Senate recessed on Friday without considering the bill, H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, it pushed off a vote until mid-April.

The bill’s supporters were hoping for a Senate vote last week because, as Jennifer Haberkorn, of Politico Pro, and Mary Agnes Carey explained for Kaiser Health News, the Senate’s return date of April 13 leaves two weeks for those who like the bill and those who don’t to gather support and consider their options.

“Traditionally in Washington, the more time you have, the more opportunity there is for opposition to fester. That should be a concern in this case because it is two weeks before the Senate returns,” Haberkorn said. Continue reading →

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Medicare ‘doc fix,’ passed by House, shifts some costs to seniors

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Image by 401(K) 2012 via Flickr

Image by 401(K) 2012 via Flickr

The U.S. House of Representatives passed H.R. 2 on Thursday, a bill that would prevent an automatic cut of 21 percent in Medicare payments to physicians and would require seniors to pay more in the form of higher copayments and premiums. The Medicare Access and CHIP Reauthorization Act of 2015 also would extend the Children’s Health Insurance Program (CHIP) for two years through 2017.

The vote was hailed as a step forward for physicians because it eliminates the formula Congress has used for many years to increase payments to physicians. That formula, called the sustainable growth rate (SGR), was renegotiated annually and usually at the last minute. It’s been replaced with an annual payment increase of 0.5 percent. The vote was 392 to 37, including 212 Republicans and 180 Democrats voting in favor, according to Govtrack.us.

The strong support from both Republicans and Democrats puts pressure on the U.S. Senate to approve the bill, before Congress adjourns on Friday, Paul Demko wrote in Modern Healthcare. Continue reading →

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Key congressional committees agree on ‘Doc Fix’

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An agreement has finally been reached in both houses of Congress that replaces the Medicare physician sustainable growth rate formula, or SGR, with plan that provides stable funding updates based pay-for-performance and increases reimbursements by 0.5 percent annually for the next five years. The SGR, part of the 1997 Balanced Budget amendment, essentially ensured that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP.

However, as health care costs began to outpace inflation, the SGR began to fall short of the actual cost of health care services and Congress has repeatedly stepped in to suspend or adjust the payments (“doc fix”). Many physicians groups, including the AMA, have called for a more permanent, less formulaic, solution. Continue reading →

Liz Seegert is an independent health journalist and AHCJ’s topic leader on aging. She covers older adults, baby boomers, health policy, and social determinants of health, as well as many other health issues. Her bylines include stories for PBS/NextAvenue.org. the American Journal of Nursing, TIME Health, Medscape, Consumer Reports, and Medical Economics, as well as dozens of other trade and mainstream media. Her articles have been syndicated in Forbes.com, the Los Angeles Times, the Hartford Courant, the Saturday Evening Post and other major outlets.