Medicare Sustainable Growth Rate - American Society of Anesthesiologists (ASA)

Medicare Sustainable Growth Rate

The Medicare Access and CHIP Reauthorization ACT (MACRA) of 2015 abolishes the Medicare Sustainable Growth Rate (SGR) payment formula. In this 45-minute webinar, practice management experts present the most critical aspects of this new payment paradigm, exploring how MACRA came to be and why it’s vital that you become familiar with its complexities.

Key Information: 

In April 2014, Congress passed a 12-month patch to avert a 24.1 percent cut to Medicare physician payment per the Sustainable Growth Rate (SGR) formula.  This patch legislation included a 0 percent update from Jan. 1, 2014 to April 1, 2014. The legislation also included other provisions that have typically been included with previous SGR patch legislation, such as an extension of the geographic practice cost index (GPCI) floor and a delay of the transition to ICD-10-CM/PCS until Oct. 1, 2015.

On March 26, 2015, the House of Representatives passed bipartisan legislation, HR 2, which repeals and replaces the flawed Medicare Sustainable Growth Rate (SGR) formula. Included in this legislation were provisions that 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).  Read more about this legislation here.  The Senate must pass this legislation by April 1 to avoid a 21 percent cut to Medicare payments.

ASA's Position on the Sustainable Growth Rate (SGR) formula:

ASA strongly supports Congress’ work to repeal, once and for all, the flawed Medicare Physician Fee Schedule Sustainable Growth Rate (SGR) formula.  ASA looks forward to working with lawmakers and the Centers for Medicare and Medicaid Services (CMS) to play a meaningful role in helping to shape the implementation of new payment structures.

ASA opposes the across-the-board funding cuts known as sequestration.

Important Documents:

ASA One-Pager on SGR and Payment

Timeline of Congressional Action on SGR:

March 26, 2015: House Passes SGR Permanent Repeal Legislation

March 26, 2015: Statement of ASA President J.P. Abenstein, M.S.E.E., M.D. on Congressional Action to Repeal and Replace the Medicare Sustainable Growth Rate (SGR) Formula

March 19, 2015: Details of SGR Replacement Bill Unveiled – Vote Likely Next Week

March 13, 2015: House Considering Medicare Vote Next Week

April 3, 2014: SGR Patch Legislation Signed into Law, Includes ICD-10 Delay

March 20, 2014: Congressional Budget Office Estimates Cost of Senate SGR Reform Measure at $180.2 Billion Over 11 years

March 14, 2014: House Passes SGR Repeal with Individual Mandate Offset

March 13, 2014: House to Vote on SGR Repeal - CBO Scores Individual Mandate Delay as Offset for Repeal Legislation

February 06, 2014: Key Lawmakers Announce Bicameral Bipartisan Deal to Replace SGR

January 30, 2014: Congressional Budget Office Issues Cost Estimate for Legislation to Repeal and Replace SGR

December 23, 2013: Senate Passes Budget Deal Including 3 Month SGR Patch

December 12, 2013: House Ways & Means and Senate Finance Committees Consider and Pass SGR Repeal and Replacement Legislation

December 06, 2013: ASA Joins Coalition Partners in Opposing Congressional Committees' Most Recent Revised Draft Legislation to Repeal and Replace SGR, Interim 3 Month SGR Patch Expected

November 12, 2013: ASA Offers Recommendations on Most Recent SGR Repeal and Replace Proposal

November 05, 2013: New SGR Repeal and Replace Proposal Introduced by Key Senate and House Committees

September 13, 2013: Congressional Budget Office Projects Cost of SGR Bill at over 175 Billion

July 31, 2013: House Energy & Commerce Committee Passes SGR Replacement Bill

July 30, 2013: ASA Expresses Support for Key Provisions of House Committee’s SGR Replacement Bill, Urges Changes to Harmful Provision

July 19, 2013: House Energy & Commerce Committee Releases Draft SGR Replacement Legislation and Schedules Consideration for Monday

July 12. 2013: ASA Responds to Latest Request in SGR Reform Discussion

June 28, 2013: House Energy and Commerce Committee Releases Revised Legislative Framework for SGR Reform

June 11, 2013:  ASA Continues Participation in SGR Reform Discussion

May 28, 2013:  House Energy and Commerce Committee Leadership Unveil SGR Repeal and Replacement Legislation

April 16, 2013:  ASA Continues SGR Reform Discussion Tied to Quality

February 28, 2013:  ASA Participates in Congressional SGR Reform Discussion Tied to Quality

January 03, 2013:  House Approves Senate "Cliff" Package, President Expected to Sign

January 02, 2013:  Senate Approves "Cliff" Package Including SGR Patch - House Considers Action

December 24, 2012:  Stalled Fiscal Cliff Negotiations Threaten Attempts to Avert 27 Percent SGR and 2 Percent Sequestration Cuts to Medicare Effective January 1, 2013

December 19, 2012:  CMS Issues Announcement Regarding Claims Payments Pending Congressional Action on SGR

November 13, 2012:  Congress to Meet About Looming "Fiscal Cliff" that Includes SGR and Separate Sequestration Medicare Cuts

September 12, 2012:  ASA and Medical Groups Urge Congress to Block Sequestration and SGR Medicare Payment Cuts

February 17, 2012:  House and Senate Pass Final Version of HR3630 10 Month SGR Extension Included

February 10, 2012:  ASA Letter to Congressional Negotiaters: Now is the Time to Repeal SGR and IPAB

December 22, 2011:  Deal Reached on H.R .3630, SGR Cuts Averted

December 20, 2011:  SGR Issue Remains Unresolved After Contentious Day on the House Floor

December 14, 2011:  Package Containing SGR Fix Passes House of Representatives, Senate Democrats and White House to Oppose 

December 9, 2011:  SGR Update: House Republicans Unveil Package Containing  2-Year SGR Patch With 1 Percent Payment Increase 

December 7, 2011:  SGR Update: Congressional Leaders Continue to Work to Address Pending Payment Cut

December 9, 2010:  House Passes 12-month SGR Fix, 25 Percent Payment Cut Averted

December 8, 2010:  President Obama Supports 12-month SGR Fix

December 8, 2010:  12-Month SGR Deal Passes Senate

November 29, 2010:  House Passes and President Obama Signs One-Month SGR Fix

November 19, 2010:  Senate Passes One-Month SGR Fix; House Yet to Act

September 28, 2010:  Congress Adjourns: November 30th SGR Cut Pending

June 21, 2010:  President Signs "Doc-Fix" Bill into Law That prevents SGR Cuts Through November 30, 2010

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