Sustainable Growth Rate Legislation AKA "The Doc Fix"

Sustainable Growth Rate Legislation AKA "The Doc Fix"

As a preface, the SGR has been an ongoing problem for providers serving Medicare patients and their beneficiaries. In the past, a "doc fix" has been applied to prevent massive Medicare reimbursement rate cuts, which ultimately would end up in fewer physicians available to treat Medicare patients. Congress is attempting to pass a comprehensive bill that will "fix" the problem (one that rewards quantity of services rather than quality of care) rather than doing an annual patch, which has been the practice for the last ten years.

This is a huge deal for our profession, but also the future of healthcare. Many professional PAs believe that this bill could make or break the profession, which is why it is so important that you are active in pursuing its passage. The SGR bills were both recently passed out of the House and Senate committees and will move to the floor of both chambers sometime in the first few months of 2014. AAPA has been HEAVILY engaged in the development of the bills, as well as some of the amendments which were included in the bills. PAs in the states of the relevant senators have been interviewed and have conveyed personal stories to their senators to help garner support.

Once AAPA finds out early this year what the next steps are for the SGR legislation, they will put out a call to action to AAPA members asking for their support and for them to contact members of Congress to ask them to support these PA provisions. PAFT (PAs for Tomorrow) and their many members are the best advocates they have for the profession. Additionally, other healthcare organizations with aligned interests and Congress are working with them directly on this matter.

What You Need to Know:

• On January 1, 2014 - Medicare took nearly a 24% payment cut 
• Congress planned to override the budget cut by using Medicare's Sustainable Growth Rate (SGR) formula + a 0.5% increase for payments to healthcare professionals through April 1, 2014
• 3-month "patchwork" passed December 12th
• US Senate is expected to accept this agreement
• House & Senate wish to REPEAL the SGR and REFORM Medicare's payment system = THIS IS GOOD FOR PAs
• Fee-for-service system moves toward value-based performance (VBP) program
• Incentives to develop alternative payment models (APM) - begin in 2016
• Medical Homes
• Accountable Care Organizations (ACOs)
• Bundled Payments
• Centers for Medicare and Medicaid Innovation Programs
• Takes into account quality, resource use, and practice improvements
• VBP Applies to payments for items and services furnished AFTER January 1, 2017
• New Legislation Made
• PAs treated same way as physicians and nurse practitioners in FFS, VBP and APM
• Everyone eligible to provide chronic care management through SGR reform bills 
• A few possible amendments to Senate Finance Committee's bill
• Amends Medicare, allowing PAs to provide and manage hospice care for Medicare beneficiaries (R-WY and D-DE sponsored)
• Clairifies that general supervision by a physician or non-physician is allowed at critical access hospitals (CAHs) for payment of therpeutic hospital outpatient services and that non-physician practioners may directly supervise cardiac and pulmonary rehab services (SD, D-CO, R-WY, R-KS sponsored).  
• January 2014
• Congress determines "payfors" - these are cost offsets for enacting the reform
• Then goes to House and Senate for debate and vote 
• February 2014
• SGR Repeal and Medical Provider Payment Modernization Act - introduced

The overarching message here is that all PAs deserve to be treated equally as physicians and nurse practitioners do, whether a new benefit or quality measure. Laws should not create a double standard for any one group of people, especially in healthcare. The patients being treated are ultimately the one's suffering from lack of access to the care they need and deserve. If that is what limiting rights to providing care means to law makers, then they have some serious decisions to make about their own profession. Limitations only create barriers for success, and the quality of our healthcare system is at stake when you infringe upon the success of America's PAs.

For all interested, work on reforming the SGR can be followed here.

The senate legislation update can be found here.

Find your congressional representatives here.