Capitol Hill Report: House Passes SGR Repeal, Senate Up Next

March 24, 2014

by Michael J. Amery, Esq., Legislative Counsel

Contact Your Senators Now
Congress was out of session last week but before leaving, the House passed legislation (HR. 4015) to repeal the Sustainable Growth Rate (SGR) Medicare physician payment system. That is great news except for the fact that House Republicans paid for the $138 billion cost by delaying the Affordable Care Act's individual mandate for five years. Predictably, the 238-181 vote largely was along partisan lines, with only 12 Democrats voting in favor.

Everyone has been pressing for the SGR vote to be bipartisan. Readers of Capitol Hill Report know that the policy that has been developed to this point has been supported by both Republicans and Democrats alike, but now we fall into partisanship. Why?

I had the great opportunity to participate in a medical specialty breakfast with most of the 17 Republican physicians in the House just two hours before the vote. Key members like HR 4015 author Rep. Michael Burgess, MD, (TX) and Reps. Tom Price, MD, (GA), Joe Heck, DO, (NV), and Phil Roe, MD, (TN), described their efforts in trying to get the Senate to come to the table to talk about real offsets. Time and time again they were ignored, so the result was a partisan pay-for in attempt to get the Senate to act.

Will it work?

Just after the House vote, Derek Brandt and I participated in a meeting with top staff from the new chair of the Senate Finance Committee, Ron Wyden (D-OR). Wyden's staff said that they are committed to passing a SGR repeal bill prior to the expiration of the current patch on April 1. The problem will be getting 60 votes to overcome the threat of a Republican filibuster that may target the bill for likely having no offsets for the cost.

The goal is to get those 60 votes so we will have bills passed through both houses of Congress in which everyone agrees with the policy and only the offsets will be left to negotiate.

Wyden's staff said that if the bill (S. 2110) passes the Senate, the chairman will talk to anyone to get a deal that permanently repeals the SGR before another patch is needed to prevent the looming 24-percent Medicare physician cut.

However, if the bill fails in the Senate or Congress cannot come to an agreement on a permanent repeal before April 1, then Wyden will work for a nine-month patch, but will not be spending significant time on the SGR for the rest of 2014. The patch will likely include cuts to physician payments.

Now is the time to make this SGR fix happen. What every US AAN member must do is contact their senators and tell them to pass the SGR repeal bill regardless of the offsets. If the Senate votes, it will be at the end of this week so don't delay. Take just 90 seconds to respond to the AAN Action Alert sent on March 23 or pick up the phone and give your senators a call. The US Capitol switchboard is (202) 224-3121. An operator will connect you directly with the Senate office you request.

For an interesting look at this issue, read this National Journal one-page chart.

Regulatory Corner
by Daneen Grooms, MHSA, Regulatory Affairs Manager

MedPAC's March 2014 Report Includes Mixed Recommendations for Neurology 
Each year, the Medicare Payment Advisory Commission (MedPAC) is required by law to review Medicare payment policies and to make recommendations to Congress. Congress, however, does not always act upon these recommendations. The March report outlines the commission's recommendations for annual rate adjustments under Medicare's fee-for-service program. 

For the 2015 payment year, MedPAC recommends that Congress direct the Secretary of Health and Human Services to:

  • Eliminate differences in payment rates between outpatient departments and physician offices for imaging tests such as MRI and magnetic resonance angiography. In other words, outpatient departments should receive the same payment as physician's offices.

It was noted that these services are generally performed in a physician's office more than 50 percent of the time and that they are infrequently provided with an ED visit.

  • Repeal the SGR and replace it with a 10-year path payment rate update that is higher for primary care services than for specialty services.

While the AAN agrees that repealing the SGR is urgent, we disagree with this approach. The issue is nonprocedural specialties (e.g., neurology) vs. procedural specialties;  not primary care vs. specialty care. Any updates that benefit primary care should be extended to all providers who primarily provide E/M services because we have the same workforce and recruitment challenges as primary care. In fact, the AAN met with MedPAC staff in February to make this argument and we will continue to voice our position to MedPAC, CMS, and Congress.

Prepare Your Practice: Enrollment in Health Insurance Exchanges Ends March 31 
If you haven't already, you can expect to start caring for patients who have elected coverage through the federal or their state-based health insurance exchange. It is important that you have policies in place that allow for smooth operation of your practice. Under the law, patients who are receiving a federal subsidy to purchase an exchange plan have a 90-day "grace period" to pay their premiums. In turn, health insurers are required to pay physicians for care provided in the first month but can pend-and ultimately deny-claims for months two and three of the grace period if the patient fails to pay their premium. By allowing issuers to "pend" claims during months two and three of the grace period, the law has unfairly shifted the burden and risk of nonpayment of premiums to physicians.

In response, the American Medical Association has created a toolkit to help physicians navigate the potential issues created by the "grace period." The new toolkit is available on under the Health Insurance Marketplace heading and includes:

  • A step-by-step guide to the "grace period" including information about how physicians can communicate with patients who are in the grace period 
  • Grace period collections policy checklist
  • Sample letter: Grace period notice to patients


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