An SGR Deal is Real!

As difficult as this may be to believe, Congress claims to have reached a deal to repeal the sustainable growth rate formula, but amidst celebrations people seemed to have missed the difficult hurdle still ahead.

As difficult as this may be to believe, Congress claims to have reached a deal to repeal the sustainable growth rate formula, according to MedPage Today.

The bipartisan team of House and Senate negotiators announced the deal Thursday after nearly a year of drafting legislation. For the next five years, physicians will get a 0.5% pay increase designed to “provide payment stability and help physicians transition to new models of care,” according to MedPage.

All that is currently available is a one-page summary reveals some of the details of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 include incentives for care coordination for patients with chronic care needs, existing payment incentive programs will be consolidated into a single Value-Based Performance Incentive Program and payment data on providers will be more publicly available.

The one-page summary also reveals that doctors who receive at least 25% of their Medicare revenue from an alternative payment model (such as an Accountable Care Organization or a Patient-Centered Medical Home) through 2018 will also receive a 5% bonus.

According to FierceHealthcare, most of the House GOP Doctors Caucus were disappointed that the deal only includes a five-year payment update (originally 10 years were planned), but they endorsed the deal.

The American Medical Association’s president, Ardis Dee Hoven, MD, released a statement applauding the House and Senate negotiators for the months of bipartisan, bicameral work to reach the “landmark” agreement.

"Congress has been debating the shortcoming of the SGR policy for more than decade,” Hoven said in the statement. “Continuing the cycle of short-term patches by merely addressing the 2014 cut that is imminent on April 1 without solving the underlying problem would be fiscally irresponsible and further undermine the Medicare program.”

The American College of Physicians also voiced its own support of the legislation and Charles Cutler, MD, FACP, chair of the Board of Regents, stated his and the ACP's determination to get this bill to the president for his signature no later than March 31 in order to prevent the 24% payment cut still scheduled for April 1.

However, the National Journal pointed out what everyone else seems to be overlooking amidst the celebration of the compromise reached: no one has agreed how to pay for the repeal.

“Neither bill includes measures to offset the spending—a hole that could sink it among the Hill's budget hawks,” writes Clara Ritger. “And as Congress debates where to cut or where to get new revenue to offset the spending, the deal's bipartisan support could splinter.”

The Congressional Budget Office will do a cost estimate.