Dr. Blog

House and Senate Extend SGR Fix through 2011

The House of Representatives has passed H.R. 4994, the "Medicare and Medicaid Extenders Act of 2010," on a bipartisan vote of 409-2. This legislation, which passed the Senate on Dec. 8 by unanimous consent, stabilizes Medicare physician payments at current rates through the end of 2011, thereby preventing the 25 percent Medicare physician payment cut scheduled to take effect on Jan. 1, 2011. This legislation will now be sent to the White House for President Obama to sign into law.

In addition to preventing the Medicare physician payment cut, the bill extends a number of payment policies that were set to expire at the end of this year, including:

• The "floor" on geographic adjustments made for the physician work component of the Medicare payment schedule.
• The 5 percent payment increase for certain Medicare mental health services.
• An exceptions process for the cap on Medicare outpatient therapy services.
• Payments for the technical component for certain pathology services.

It also includes funds to enable Medicare contractors to reprocess claims for physician services affected by provisions of the Patient Protection and Affordable Care Act passed last spring with a retroactive effective date of Jan. 1, 2010. These include revisions to the geographic payment adjustments, increased payments for bone density tests, and other policies.

The OMA joined the AMA and other medical societies and advocacy groups across the country in urging Congress to pass this legislation. This 12-month fix should give Congress time to develop a new Medicare physician payment formula to replace the problematic Sustainable Growth Rate formula. There seems to be bipartisan agreement that it is time to end the cycle of recurring stop-gap measures that only postpone Medicare physician payment cuts and make full SGR repeal more and more expensive. In a statement issued yesterday, President Obama said, “It’s time for a permanent solution that seniors and their doctors can depend on and I look forward to working with Congress to address this matter once and for all in the coming year.”

House and Senate Approve 31-Day SGR Fix

On Nov. 18, the U.S. Senate approved a bill by unanimous consent that grants a 31-day reprieve from the 23 percent Medicare physician payment cut scheduled to take effect on Dec. 1 because of the flawed Sustainable Growth Rate payment formula. The House of Representatives approved the legislation, “The Physician Payment and Therapy Relief Act of 2010,” by a voice vote on Nov. 29, and it will now be sent to the White House to be signed into law. This short-term fix is intended to prevent disruption in payments while Congressional leaders continue to seek funding offsets for legislation that will stabilize Medicare physician payments through 2011.

Earlier this fall, the OMA joined the AMA, state medical societies and 66 national physician organizations in asking Congress to take action during the lame duck session and implement an SGR fix through Dec. 31, 2011. Extending the SGR fix for another year would prevent the loss of $150 million for the care of elderly and disabled patients in Oregon. The OMA is advocating for this proposal, while maintaining the ultimate goal of permanently repealing the flawed Medicare payment formula.

On Nov. 17, OMA members and physicians across the country took part in the AMA’s “White Coat Wednesday,” a national grassroots campaign to urge Congress to address the SGR problem before payment cuts go into effect. Nationwide, over 10,000 calls were made to members of Congress.

The lame duck Congressional session is expected to continue for up to three weeks, during which time additional legislation must be passed to stop a 25 percent Medicare physician payment cut that is scheduled for Jan. 1, 2011. 

The OMA, along with the AMA and its Federation partners, will continue to urge Congress to provide stable physician payments through the end of 2011, until a new payment proposal can be developed to replace the Sustainable Growth Rate formula. This position enjoys bipartisan support, both in Congress and in the White House. Bicameral and bipartisan efforts are underway to identify budgetary offsets for the 10-year cost of stopping the 2011 cut.