SGR finally repealed!

[Gfunk6]

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Members don't see this ad.

Thought that the below bullet points would be helpful for discussion. Keep in mind that some of the bullet points below only apply to California . . .

Below is a brief summary of the major provisions of H.R. 2:

• Repeals the SGR
• Provides automatic, stable 0.5% updates starting in July 2015, continuing each year until 2019
• In 2019, physicians can choose to participate in one of two payment track options:
  • 1: Maintains a Fee-for-Service Track that simplifies and consolidates the existing quality reporting programs, reinstates large bonuses of up to 9%, and reduces current penalties
  • 2: The Alternative Payment Model Track provides 5% bonus payments and allows physicians to develop the new models, such as primary care/specialty medical homes.
• Physicians are also required to be involved in defining quality;
• $125 million in funding to help small practice physicians transition to the alternative models or quality reporting programs;
• Reinstates bundled payments for the 10-day and 90-day global surgical services;
• Provides total cost of care data to help physicians better manage their practices;
• Mandates interoperability of EHR systems;
• Extends the expiring Children's Health Insurance Program (CHIP) for 2 years at the higher ACA funding levels: It covers nearly 1 million children in California who would otherwise lose their insurance. CHIP was formerly known as Healthy Families in California before it was folded into the Medi-Cal program. However, it still enjoys a 60% federal funding match.
• Extends the expiring Community Health Center funding.
• Extends the important National Health Service Corps Program and the Teaching Health Centers Rural Primary Care Residency Training Programs (created in the ACA) through 2017. There are several teaching health center residency programs in California.
  
• Makes permanent the Qualifying Individual Medicare program that helps low-income seniors pay for premiums and continues the Transitional Medical Assistance Program for Medicaid families transitioning from welfare to work.
• Extends the moratorium on RAC audits of the hospital two-midnight rule which helps hospitals and physicians.
  
• Delays the ACA cuts to Disproportionate Share Hospitals for one more year.
• Stipulates that no federal healthcare provision shall be interpreted as creating a duty of care of the standard of care in a medical liability lawsuit, a provision that medical professional liability insurance carriers have lobbied for the with the support of AMA, CMA and ACCMA.

 

[Gfunk6]

I should mention that the above list was taken from the ACCMA (our local medical society in CA).

 

[CyberKnife19]

I should mention that the above list was taken from the ACCMA (our local medical society in CA).

GFunk, for those of us still in residency and not business savvy, could you please elaborate on the ramifications or implications for our specialty specifically?

 

[xrthopeful]

GFunk, for those of us still in residency and not business savvy, could you please elaborate on the ramifications or implications for our specialty specifically?

Cosigned. Also, what does this mean for people not in California

 

[Gfunk6]

The SGR (sustainable growth rate) was originally passed by Congress in 1997. It was recognized then that Medicare costs were beginning to spiral out of control and this act was to try to cost contain them. It pegged Medicare expenditures as a percentage of GDP. After a certain number of years, it became clear that Medicare reimbursement needed to be CUT to meet the law. However, nobody in Congress had the cajones to cut Medicare reimbursement due to the lobbyists so they continue to "patch" it year after year without any long-term planning.

Finally, this year they repealed SGR and made the following changes that are germane to Rad Onc:

1. 0.5% annual (cumulative) increase to all Medicare reimbursements from 20215-2019
2. In 2019 they will begin to experiment with an 'alternative' reimbursement model:
   1. Fee for service - if you choose this and keep the status quo, your fees will be pegged on some relevant metric. For Rad Onc this is in the process of being defined. However, if ASTRO has its way then they may push for a certain % of your bone met patients to be single fraction, a certain % of breast CA patients to receive hypofractionation, etc.
   2. Alternative payment model - this is only possible in hospitals or large multi-specialty groups. The idea is that you have a large number of "lives" in your health network and you try to cost contain by keeping everything within network. This will prevent redundant labs, imaging, and other diagnostic studies. This will also encourage MDs to cost contain because you will receive a "lump sum" for your work.
3. All the rage is quality metrics and how exactly to define that. This legislation mandates physician participation.
4. A modest amount of money to help small practices transition to the alternative payment model. Realistically though, most practices needing assistance to do this in 2019 will be DOA.
5. Medicare, at some point, will start sharing data on the global cost of care for each cancer diagnosis which will help physicians cost contain.
6. All EMRs are supposed to speak to each other. In my opinion this is a pipe dream and if the feds push it then someone like Epic will end up having a federally-subsidized monopoly on EMR.

Those are the main points.

 

[Gfunk6]

Some thoughts regarding the SGR appeal from the ASTRO PAC:

"It’s official. We are now living in a post-SGR world. Following two historic votes in Congress, the SGR repeal legislation was signed by President Obama into law last week.
This is proof that our advocacy efforts work!

ASTRO PAC played a critical role in repealing the SGR, working hand in hand with our lobbying efforts, by allowing us to develop relationships and have face-to-face conversations with members of Congress. Even though the SGR is no longer a threat, our work is not done. This July CMS will release its proposed rule where we expect to see more than half of the reimbursement codes for radiation oncology revalued. With so much uncertainty and so much at risk, we need to keep working hard to support our Congressional champions for help if needed. "