House Republicans Vow To Permanently Repeal, Replace SGR Formula

On Wednesday, House Republicans vowed to pass legislation this year that would permanently repeal the sustainable growth rate formula -- which sets Medicare physician reimbursement rates -- and introduce a replacement, The Hill's "Healthwatch" reports (Viebeck, "Healthwatch," The Hill, 2/13).

Congress routinely has passed legislation to delay cuts called for by the SGR, but physicians face substantial reductions in their Medicare reimbursements each time the "doc fix" expires. The most recent doc fix delayed the cuts until Jan. 1, 2014, at which time physicians face about a 25% reduction to their Medicare reimbursement rates (California Healthline, 2/8).

At an American Medical Association conference on Wednesday, House Energy and Commerce Committee Chair Fred Upton (R-Mich.) noted that a recent report by the Congressional Budget Office lowered its 10-year cost estimate for eliminating the SGR, from $245 billion to $138 billion. Upton said the report offers "a window of opportunity" for change, adding that it is "a very large amount but a smaller mountain to climb."

Upton pledged to introduce the bill on the House floor this summer, in hopes of passing the legislation by the end of the year. He said he hopes to gain bipartisan support for the House bill, which would increase the bill's chances in the Democratic-controlled Senate (Morgan, Reuters, 2/13).

On Thursday, Upton and lawmakers on the panel's health subcommittee will hold a hearing to develop a new framework for Medicare physician reimbursement. A three-part blueprint released last week calls for a repeal of the SGR and a period of stable payment updates, followed by a shift to new payment models that reward physicians based on quality and efficiency (Ethridge, CQ Roll Call, 2/13).

Upton Criticizes Obama for Failure To Address SGR in ACA

Upton on Wednesday also criticized President Obama for not including a permanent solution to the SGR in the Affordable Care Act. Obama "deliberately failed to address what has been the greatest threat in the medical profession since the last decade," Upton said ("Healthwatch," The Hill, 2/13).