12-Month SGR Fix in House Requires Referrers to Consult Appropriateness Criteria

While a long-term solution to the sustainable growth-rate (SGR) problem has slid to the backburner, a bipartisan 12-month SGR fix has emerged in the U.S. House of Representatives that would preserve physician compensation levels—and require referring physicians to consult appropriateness criteria when ordering advanced medical imaging procedures for Medicare patients.

Coming just days before the current temporary fix is scheduled to expire and set in motion a 24% physician pay cut, the bill would empower the secretary of the U.S. Department of Health and Human Services to determine which mechanisms referring physicians could use to access these criteria.

The ACR was quick to issue a statement of support. “The imaging appropriateness criteria provisions in this SGR bill will help ensure that patients get the right exam for the right condition and avoid care they may not need,” said Paul H. Ellenbogen, M.D., F.A.C.R., chair of the ACR board of chancellors, in the statement. “This would raise quality of care and preserve resources without intruding in the doctor-patient relationship or affecting access to care.”

According to an article in Modern Healthcare, a deal was struck between House Speaker John Boehner (R-Ohio) and Senate Majority Leader Harry Reid (D-Nev.) to craft the quick fix as House and Senate leaders haggle over a way to pay for a more long-term solution, such as the repeal or replacement of the current SGR formula. A House vote is expected Thursday, followed by a vote in the Senate on Friday if approved by the House, according to the article.

The American Medical Association came out against the temporary patch, calling on Congress to enact a full repeal of the SGR instead. "By extending the Medicare provider sequester and “cherry picking” a number of cost savings provisions included in the bipartisan, bicameral framework, the “Protecting Access to Medicare Act” actually undermines future passage of the permanent repeal framework," said Ardi Dee Hoven, M.D., president, AMA, in a prepared statement. "Further, it would perpetuate the program instability that now impedes the development and adoption of health care delivery and payment innovation that can improve health care and strengthen the Medicare program"

The ACR also announced its support of several other provisions in the bill, notably a mandate that would require CMS to phase in cuts to medical services greater than 20 percent over two years; the requirement for CMS to produce the data used to justify the 25 percent MPPR to the professional component for specified imaging procedures provided to the same patient on the same day in the same session; and a delay to the implementation of ICD-10 provider payment codes.

Concern was expressed, however, about “broad statutory expansion of the authority of the secretary of the U.S. Department of Health and Human Services (HHS) to revalue Medicare physician payments based on a large number of criteria to be used at the secretary’s discretion.”