Advocacy & Health Policy: After Over 15 Year Fight, Flawed Medicare SGR Replaced
Medicare’s Sustainable Growth Rate (SGR) formula is no more! After over a decade of threatening physicians with double digit payment cuts, ACOG, its members, and the physician community successfully pushed Congress to replace this failed policy.
What exactly is in the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015? First, it is very similar to H.R. 4015/S 2000 from the 113th Congress – bipartisan, ACOG-supported legislation that was a top ask at ACOG’s 2014 Congressional Leadership Conference. To learn more about the nuts and bolts of the bill, click here.
ACOG has been hard at work ensuring that ob-gyns were at the table from the start. You can see ACOG’s particular imprint on the new law, and the many ways ACOG worked to make sure it works for its members, in the highlights below.
This truly is a watershed moment for ob-gyns and our patients.
Dr. Jennings and Sue Ellen celebrate SGR Repeal
Top ACOG Wins:
- Reliable Payment Increases for the First Five Years: Ensures a period of stability with modest Medicare payment increases for five years, plus no cuts with opportunity for payment increases for the next five years.
- Protection for Low Medicare Volume Physician Practices: Ob-gyns and other physicians with a small Medicare patient population are exempt from many program requirements and penalties.
- Physician Liability Protections: Ensures that federal quality measurements cannot be used to imply medical negligence and generate lawsuits.
- Protected Ultrasound: No cuts to ultrasound reimbursement.
- Penalties Ended: Penalties related to Electronic Health Records (EHR) Meaningful Use, Physician Quality Reporting System, and use of the Value-Based Modifier end in 2018.
- Alternative Payment Model (APM) Bonus Payments: Bonus-eligibility for APM participation is based on patient volume, not just revenue, to make it easier for ob-gyns to qualify.
- Children’s Health Insurance Program (CHIP): Includes a 2-year extension of program that provides comprehensive coverage to hundreds of thousands of pregnant women and millions of adolescent girls across the country.
- Quality Measure Development: Helps professional organizations, like ACOG, develop quality measures for the Merit-Based Incentive Payment System (MIPS), rather than being developed by a federal agency, ensuring that this new program works for physicians.
- Stops CMS Policy on Global Surgical Codes: Halts implementation of Center for Medicare and Medicaid Services plan to unbundle all 10- and 90-day global codes, and ensures instead a thorough, data-driven approach to appropriately valuing surgical services, including those provided by ob-gyn subspecialists, such as urogynecologists and gynecologic oncologists.
- Extension of Key Programs of Importance to Ob-gyn: Funding extensions to Medicaid/CHIP Pediatric Quality Measures Program, Community Health Centers, National Health Service Corps, and Teaching Health Center Graduate Medical Education Payment Program.