SGR Repeal Fails, Legislation Delays Payment Cuts for One Year

Despite a last ditch effort by Senate Finance Committee Chairman Ron Wyden to permanently repeal and replace the Sustainable Growth Rate (SGR) formula, the Senate passed the Protecting Access to Medicare Act of 2014 (H.R. 4302) on March 31 in a vote of 64-35. The legislation, which delays for 12 months a 24 percent Medicare physician payment cut that was set to kick in April 1, is the 17th patch that Congress has enacted since 1997. Last week, the House passed the bill by voice vote.

While the legislation includes provisions the ACC has advocated for within the scope of full SGR repeal, failure to permanently repeal the SGR given the significant bipartisan/bicameral legislative efforts this year represents a wasted opportunity to finally provide much needed stability within Medicare.

Key provisions in the legislation include:

  • Prevents 24 percent cut scheduled for April 1, 2014; provides a .5 percent update through Dec. 31, 2014, and a 0 percent update from Jan. 1 - March 31, 2015
  • Requires consultation with appropriate use criteria and clinical decision support for advanced diagnostic imaging, beginning in 2017
  • Allows the Health and Human Services (HHS) Secretary to revise payments for potentially misvalued codes within the physician fee schedule beginning in 2017 based on information collected from providers
  • Extends HHS Secretary’s medical review activities regarding the “Two Midnight Rule” for the first six months of 2015, delaying enforcement of the rule
  • Delays the transition to ICD-10 for one year
  • Extends funding for the National Quality Forum for measure endorsement through July 2015
  • Requires all CT services to be provided by equipment adhering to NEMA dose standards, beginning January 2016
  • Consolidates the 2 percent Medicare sequester cut scheduled for full-year 2024 into a 4 percent cut in the first six months of 2024.

Additional details on the provisions are available here. Stay tuned for updates on how these provisions will impact cardiology over the next year.

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