Details of SGR Replacement Bill Unveiled – Vote Likely Next Week

On Thursday, March 19, a bipartisan group of lawmakers from both the U.S. House of Representatives and U.S. Senate introduced legislation to repeal and replace the flawed Medicare sustainable growth rate (SGR) formula that has systematically introduced cuts to Medicare payments each year.  The legislation is similar to legislation introduced last year in the House and Senate.

The authors of this legislation claim it would replace this system with “an improved payment system that rewards quality, efficiency, and innovation.”  In this SGR replacement, physicians would receive a 0.5 percent update for the initial five years of the law while a new system, known as the Merit-Based Incentive Payment System or MIPS, is implemented.  The MIPS program is effective in 2019.  The legislation also provides for physician participation in Alternative Payments Models (APM).

The overall legislation is expected to cost $210 billion, with $70 billion in offsets or budgetary “pay-fors.” The details of these offsets are expected to be outlined early next week.

Without action, doctors would see a 21 percent cut to Medicare payments on April 1.  Congress has taken action 17 times with temporary patches to avoid these Medicare cuts.

This SGR replacement bill was introduced by Rep. Michael C. Burgess, M.D. (R-TX), Senate Finance Committee Chairman Orrin Hatch (R-UT), House Energy and Commerce Committee Chairman Fred Upton (R-MI), House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ), House Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-PA), House Energy and Commerce Health Subcommittee Ranking Member Gene Green (D-TX), House Ways and Means Committee Chairman Paul Ryan (R-WI), House Ways and Means Committee Ranking Member Sander Levin (D-MI), House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX), House Ways and Means Health Subcommittee Ranking Member Jim McDermott (D-WA), and Rep. Charles Boustany, Jr., M.D. (R-LA). 

Leaders in both the House and Senate continue to work towards an agreement on this legislation.  Leadership has said they hope to vote on this legislation the week of March 23.  Read more about the Medicare SGR proposal here or find a section-by-section summary here.

ASA is reviewing this proposal and will continue to provide updates on the bill, including announcements of pay-fors and legislative movement.