Congress Poised to Act on Medicare Doc Fix, American Heart Association Weighs In

Updated:Mar 5,2014
Congress Poised to Act on Medicare Doc Fix, American Heart Association Weighs In

After years of temporary fixes, Congress has been actively working on legislation that would permanently replace the Sustainable Growth Rate (SGR), the formula used by Medicare to pay physicians. The legislation currently under discussion permanently repeals the SGR and replaces it with a new model designed to move away from traditional fee-for-service and reward physicians based on the quality of care they provide. The legislation provides 0.5% annual payment updates for five years while the new system is being implemented. A summary of the compromise legislation reached by the three committees of jurisdiction (the House Energy and Commerce, House Ways and Means, and Senate Finance Committees) can be found here.
As Congressional staff worked on crafting and revising this legislation, American Heart Association/American Stroke Association (AHA/ASA) staff and volunteers shared their quality improvement expertise and technical assistance. In their conversations, the AHA/ASA stressed its belief that any legislation must incorporate a number of elements in order to drive successful quality improvement and improve patient outcomes, including:
  • Development of, and adherence to, clinical practice guidelines and measures;
  • Use of clinical data registries;
  • Robust data linkage;
  • Hands-on support/technical assistance; and
  • Seamless coordination across the care continuum. 
AHA/ASA staff and volunteers also emphasized that it is imperative that in replacing the SGR, Congress not lose site of the overall goal for a reformed system – one that is based on tested and proven models, supportive of the best clinical evidence, and truly patient-centered. The comments that AHA/ASA submitted on an earlier draft of the legislation can be accessed here.
Currently, Committee staff are working to identify “offsets” that can be used to pay for the legislation, which CBO estimates will cost approximately $138 billion. The Finance Committee, however, one of the three Committees involved in this legislation, recently changed chairmen when former Senator Max Baucus (D-MT) was confirmed as Ambassador to China and Senator Ron Wyden (D-OR) replaced him. While Congressional staff have indicated that they still intend to move forward with attempts to pass this legislation, some commentators suggest that this transition and the difficulty of agreeing to payment offsets make near-term passage of a bill unlikely. A three month “patch” to the program that was passed at the end of 2013 will expire on March 31, 2014. Many commentators predict another nine month patch and deferral of broader legislation into the future that will occur when the initial patch expires. 
The AHA/ASA remains hopeful that this bipartisan and bicameral legislative effort produces a permanent fix to the SGR in order to drive the delivery of high quality health care for all patients.