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Wednesday, April 2, 2014

Congress Passes Another SGR Patch

For the 17th time in a decade, Congress has voted to delay the 24-percent cut in payment rates for physicians who accept Medicare patients. The Senate voted earlier this week to pass HR. 4302, which provides yet another temporary, 12-month patch to the Sustainable Growth Rate (SGR).

The SGR, which dictates how physicians are reimbursed for Medicare patients, was originally created by the Balanced Budget Act of 1997. Over the past decade, the cost of treating these patients has far exceeded the rate of GDP (gross domestic product) growth, so the SGR formula demands that these payments be cut. 

This latest SGR “patch” comes as a disappointment to the nearly 90 medical organizations and societies who have petitioned to repeal the SGR and enact a longer-term solution (see the letter here). 

“Unfortunately, passage of this short-term patch effectively ends the months and months of work done to develop bipartisan, bicameral legislation to permanently repeal the SGR. This is a major blow to everyone involved,” wrote Mike Amery, Esq. Legislative Counsel at the AAN.

The bill will also delay the implementation of ICD-10 diagnosis coding until Oct. 1, 2015. See Neurology Today’s advice on preparing for these changes here 

According to the AAN’s Capitol Hill Report, the additional effects of this bill include:

  • A 12-month extension of the geographic adjustment (GPCI) "floor" of 1.0 for physician work in the Medicare fee schedule
  • The Secretary of Health and Human Services would have discretion to continue suspending Recovery Audit Contractor post-payment audits under the "Two-midnight" policy through March 2015
  • Revises the laboratory fee schedule based on market-based private sector rates
  • Adjusts payments for CT equipment that does not meet certain dosage standards and implements appropriate use criteria for advanced imaging services
  • In 2024, adjustments to sequestration's physician cut would increase to 4 percent for the first six months, followed by zero percent for the second six months; this is done to amplify the impact of the cut and generate more savings

The AAN will continue to analyze and interpret the provisions of this newest patch, as well as the possible long-term solutions. Read Neurology Today’s collection of “Policy Watch” articles for more information on policy changes and how they affect your neurology practice: