Bipartisan, Bicameral Agreement on Replacing the SGR
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Bipartisan, Bicameral Agreement on Replacing the SGR

October 31, 2013

Yesterday, House and Senate leaders released a draft legislative proposal to eliminate the Sustainable Growth Rate (SGR) formula that serves as the underpinning of Medicare physician payment. Under the draft, the SGR would be repealed and replaced with a freeze on Medicare physician payment (no update) for ten years. After this period, updates would be two percent annually for providers who participate in Alternative Payment Models, and one percent for those who do not elect to participate in an alternative payment model.

Beginning in 2017, the draft proposal would establish a new Value Based Payment Performance Program. This comprehensive program would result from combining current quality incentive programs (Physician Quality Reporting System, Value-Based Modifier, and Electronic Health Records (EHR) meaningful use). Under this program, physicians could earn a bonus based on their performance. The categories for performance rating would include clinical practice improvement activities, quality measures, resource use and meaningful use of EHR.

The draft would require ordering professionals to consult with appropriate use criteria for advanced imaging services, including echocardiography. No payment would be made if the provider fails to complete this step. Providers determined to be outliers in their ordering practices would be required to complete a prior authorization process.

For more detail on this proposal, please click on the attached links.

SCCT will keep you apprised of important developments as this proposal is debated in Congress.


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