April 15, 2015 |

Senate passes SGR repeal

Update: President Barack Obama signed H.R. 2 into law on April 16.

The U.S. Senate last night voted to repeal permanently the sustainable growth rate (SGR) formula under which physicians have been reimbursed for care they provide through Medicare. The formula has been in place since 1997.

To rewatch the vote, visit C-Span's website.

The April 14 vote on the “doc fix” bill, formally known as H.R. 2 or the Medicare Access and CHIP Reauthorization Act of 2015, was 92–8 and followed 392–37 passage in the House March 26. President Barack Obama has indicated that he will sign the legislation.

“This is a historic day in Washington,” Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, said in a statement. “The Senate’s bipartisan effort to pass H.R. 2 is a proud moment for our country and will impact millions of patients, families and providers in a truly positive way. This legislation is the first step in establishing long-term stability to the profession. The next step includes a continued bipartisan effort in other important areas, such as thoughtful payment reform. We look forward to continuing our important work with Congress and delivering even more solutions for quality care.”

Cheryl Phillips, LeadingAge’s senior vice president for public policy and advocacy, said: “LeadingAge members and advocates played a critical role in pushing the ‘doc fix’ bill over the finish line. From meeting with 270 congressional offices during our PEAK Leadership Summit last month to sending more than 2,000 letters to Capitol Hill, LeadingAge members sent a clear message to lawmakers: Take the ‘doc fix’ bull by the horns, and permanently solve the problem in a bipartisan way.”

Therapy caps

Phillips added that LeadingAge will continue to remain active on the Medicare issues important to its members, including permanently repealing therapy caps and eliminating observation stays. An amendment that would have repealed a cap on the amount of therapy services Medicare beneficiaries can receive failed in the Senate by a 58–42 vote last night; 60 “yes” votes were needed for passage. Five other amendments failed as well.

AARP CEO Jo Ann Jenkins said the SGR repeal was much-needed but that the group “was disappointed that the bipartisan Cardin–Vitter amendment to remove Medicare’s arbitrary cap on physical therapy, speech-language pathology and occupational therapy services was not included. Many Medicare patients, particularly stroke victims and people with Parkinson’s and multiple sclerosis, would have benefitted.” Buoyed by the amendment’s approval by many senators, Jenkins said her group would continue to work toward the elimination of the caps.

Of cuts and costs

The Senate’s passage of H.R. 2 avoids a 21 percent pay cut that was to be imposed on Medicare physicians beginning April 1, although the Centers for Medicare & Medicaid Services had delayed the processing of claims while awaiting the outcome of the vote. The legislation changes the way physicians are compensated, moving toward quality of care rather than volume. Doctors will receive an 0.5 percent increase in pay in each of the next five years as the transition occurs. The Congressional Budget Office estimates that the bill will add $141 billion to the federal deficit; its changes will cost $210 billion, $70 billion of which will come from Medicare beneficiaries and providers.

Naushira Pandya, MD, CMD, president of AMDA–The Society for Post-Acute and Long-Term Care Medicine, said: “We thank Congress for coming together and passing this vital legislation that will reward post-acute and long-term care (PA/LTC) practitioners for the level of quality care they provide for some of the most medically complex and vulnerable individuals in our country. The monies appropriated in the legislation will help us develop meaningful and appropriate quality measures for the PA/LTC setting. We look forward to our continued work with Congress, federal agencies and other stakeholders.”

Nurses and nurse practitioners

The American Nurses Association (ANA) and the American Association of Nurse Practitioners (AANP) noted that, in addition to repealing the SGR formula related to Medicare Part B, the legislation includes provisions that enhance the roles of providers the groups represent and improve their ability to deliver services to Medicare beneficiaries. For example, the bill adds nurse practitioners and clinical nurse specialists to the list of providers permitted to document the face-to-face encounters with Medicare beneficiaries required to write prescriptions for durable medical equipment. Also, the bill incorporates advanced practice registered nurses (APRNs), including nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists, in the new Merit-Based Incentive Payment System that replcaed the SGR payment formula.

“The provisions affecting nursing in this bill recognize that nurses provide high-quality, efficient and cost-effective services that are valued and needed by Medicare patients, many of whom rely on APRNs for their primary care needs,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Nurses are more than ready to meet the quality and accountability standards for reimbursement and will continue to improve the healthcare experience for some of the nation’s most vulnerable citizens.”

David Hebert, AANP CEO, said: “The national nurse practitioner community is grateful to the U.S. Senate and House of Representatives for preserving the health services our seniors need, and further recognizing that seniors increasingly rely on the expert care of nurse practitioners who have become the providers of choice for diverse patient populations.”

Rehabilitation

The American Medical Rehabilitation Providers Association (AMRPA) also applauded the bill’s passage, saying the bill negating the need for an annual doc fix provides greater stability to Medicare beneficiaries and providers.

“We appreciate the challenges congressional leaders faced in fairly balancing provider cuts and Medicare structural reforms to achieve this bipartisan agreement,” said AMRPA Chairman Bruce M. Gans, MD, who also serves as chief medical officer for the Kessler Institute for Rehabilitation. “It’s a relief that this long-term solution to the Medicare physician payment problems will finally end what had become an annual ritual of patchwork extensions.”

Home health

The Partnership for Quality Home Healthcare (PQHH) said it was pleased with bill’s extension of an additional three percent payment for home health services provided to rural patients through the end of 2017, but the group expressed concern that Congress chose to offset a portion of the SGR legislation by cutting payments to Medicare post-acute care services, including home health. “Our community has already been subject to a series of cuts in recent years, including the 3.5 annual rebasing cuts that continue to burden quality providers and the frail, elderly Medicare population they serve,” Eric Berger, PQHH CEO, said in a statement.

The additional cut follows a four-year, 14 percent rebasing cut to Medicare home health funding that was implemented Jan. 1, 2014, PQHH said. “To protect homebound home health seniors from any further threats, we encourage Congress to secure savings through value-based purchasing programs that promote coordinated, patient-centered care over across-the-board cuts,” Berger said. “The home health community has put forth several proposals to achieve these savings, including the Securing Access Via Excellence (SAVE) Medicare Home Health Act.” The act would end the rebasing cut beginning in 2016 and put in place hospital readmission reforms to achieve savings.

Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.