American Society of Hematology

Congress Working on Legislation to Reform Physician Payment Solution

Published on: April 11, 2013

Republicans in the House of Representatives recently released a detailed version of their proposal for repealing the Sustainable Growth Rate (SGR) formula and plan to move forward with a vote this summer. In January the Congress averted a 27.5 percent cut to Medicare physician payment by delaying the deadline for the cuts until December 31, 2013 and pledging to use this year to work out a permanent solution.

Earlier this year, Republican leaders on the House Ways and Means and Energy and Commerce Committees released a three stage proposal repealing the SGR formula and calling for a period of stable payments for physician services starting January 1, 2014. The proposal focuses on stabilizing payments for an extended period of time and tying future increases to high-quality and efficient care. The updated proposal incorporates feedback from ASH and other stakeholders regarding the Committees' initial proposal.

The latest proposal provides further details and clarity on the three phases outlined in the earlier proposal. The current proposal specifies a process to reward providers for high-quality and efficient care in the fee for service (FFS) program. The proposal also includes processes to determine quality and efficiency measures that focus on evidence while being flexible and specialty-specific; recognizes the role that specialty-specific registries play in facilitating quality improvement while minimizing provider participation burden; and addresses the need for timely performance feedback to allow providers to identify improvement opportunities and optimize incentive payments. ASH is currently working on additional comments to share with Congress.

Earlier this year, Representative Allyson Y. Schwartz (D-PA) and Representative Joe Heck (R-NV) introduced a Medicare payment measure (H.R. 574) and she predicts there will be a permanent repeal this year.

Additionally, on April 10, President Barack Obama released the details of his fiscal year (FY) 2014 budget proposal and noted that "The Administration is committed to working with the Congress to reform Medicare physician payments to provide predictable payments that incentivize quality and efficiency in a fiscally responsible way."

Members of the ASH Committee on Practice will meet with members of Congress on April 16 to advocate for appropriate and stable Medicare physician reimbursement. All other ASH clinicians are strongly encouraged to join the Society's on-line advocacy campaign urging Congress to repeal the current payment formula and to find a balanced approach to deficit reduction.

back to top