SGR and Medicare Therapy Cap Exceptions Update

Medicare therapy cap
March 10, 2015
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Last year’s SGR fix and extension of the Medicare therapy cap exceptions are both set to expire at the end of this month.

As you can read in more detail in the summaries below, although there is continued talk of a permanent SGR fix, most people involved in the situation expect Congress to pass another extension that will avoid a Medicare cut, but not provide a permanent fix.

As to the Medicare therapy cap, a bill has been introduced to eliminate the Medicare therapy cap. This bill has very little chance of passing. However, I expect that as in the past few years, Congress will authorize continuation of the very broad exceptions to the Medicare therapy cap.

We should have some concrete news in the next couple weeks and I will share it with you.

Congressional Leaders Discussing Permanent SGR Fix

The Wall Street Journal (3/12, Peterson, Radnofsky, Subscription Publication) reports that House Speaker John Boehner (R-OH), Minority Leader Nancy Pelosi (D-CA) and other congressional leaders are discussing ways to permanently repeal and replace Medicare’s sustainable growth rate formula before the current short-term patch expires at the end of this month, aides said. If no deal is reached on either a permanent or short-term solution by March 31, physicians would face a 21 percent cut in Medicare payments, according to the American Medical Association.

The Hill (3/11, Ferris) reports that Sen. Ron Wyden (D-OR), the top Democratic Senator on the Senate Finance Committee, said in a statement Wednesday, “What we are hearing from the House suggests there is real movement to fully repeal and replace the flawed formula for paying Medicare providers known as SGR.” The article adds, however, that a permanent fix would be “widely unexpected for a GOP-controlled Congress that has pledged to trim federal spending,” as the move could cost as much as $174 billion.

Similarly, Politico (3/12) says it would be difficult for a deal to be reached before March 31, and some observers are expecting another temporary patch to get through September.

The AP (3/12, Fram) adds that groups including the AMA and the American College of Physicians have “lobbied to permanently end the Medicare cuts.” AMA President Robert Wah, MD, said in an interview that the temporary fixes “have created nothing but trouble for physicians, patients and Congress.”

Meanwhile, Modern Healthcare (3/11, Subscription Publication) reports that if Congress passes a temporary fix, lawmakers may “seek to placate physicians by once again delaying ICD-10 implementation, since they’ve been the biggest skeptics of the coding system.” According to the article, the American Medical Association “and its allies are stopping short of calling for a delay, at least publicly.” But some groups, such as the Texas Medical Association, “are still fighting implementation,” arguing that costly government mandates in recent years are driving physicians to consolidate their practices or go out of business altogether. “Finally, you get to the breaking point,” said Dr. Austin King, president of the TMA.

The Hill (3/11, Marcos) “Floor Action Blog” and Congressional Quarterly (3/12, Subscription Publication) also report the story.