AAFP Gears Up for Final Push on SGR Repeal in Senate

Physicians Can Continue 2015 Rates Until Legislators Take Final Action

March 30, 2015 04:50 pm News Staff

With the first hurdle to full repeal of the Medicare sustainable growth rate (SGR) crossed with bipartisan House support last week, the AAFP is making a final push on the pending legislation before the Senate returns from its spring recess.

[AAFP Advocacy]

The House moved quickly to pass the Medicare and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA), which included repeal of the SGR, but the Senate declined to take up the legislation before adjourning.

Although a 21 percent cut in Medicare payments to physicians called for by the SGR formula is scheduled to take effect April 1, CMS said it can delay the cuts for two weeks. Senate Majority Leader Mitch McConnell, R-Ky., said that the Senate will act quickly on the legislation when the session resumes on April 13.

McConnell predicted the legislation would pass by a large majority in the Senate. President Obama has indicated he supports the legislation as well, according to news reports.

Story Highlights
  • The Senate is expected to consider repealing the Medicare sustainable growth rate -- which won a strong, bipartisan victory in the House -- quickly when its spring recess ends April 13.
  • The AAFP is helping physicians reach their senators on the issue through a toll-free phone number.
  • Physicians can continue to charge 2015 rates for Medicare services rendered in April until legislators take final action.

"This is not the time to stall," said AAFP President Robert Wergin, M.D., of Milford, Neb. "The health and well-being of too many Americans depend on passage of MACRA. The Senate must act without delay."

The AAFP is helping members push for SGR repeal through a toll-free phone number -- (866) 629-5269 -- that will connect members to their senators during business hours (9 a.m. to 5 p.m. EDT). Members also can send a message through the AAFP Speak Out tool.

Last week, the AAFP signed on to a letter(1 page PDF) to McConnell and Senate Minority Leader Harry Reid, D-Nev., urging the Senate to take immediate action on the measure following an overwhelming vote of support in the House.

"This strong bipartisan vote demonstrates that a consensus now exists that the flawed SGR formula should be struck from the Medicare program once and for all," the letter reads. "After 12 years and 17 short-term 'doc fixes,' it is time to rid the Medicare program of this failed policy, and we call on the Senate to act in a timely manner, approve the House-passed SGR repeal legislation, and set our nation's health care system on a better path."

Medicare claims for services that are provided on or before March 31 will be unaffected by the payment cut and will be processed and paid according to normal procedures. Although the current SGR patch expires on March 31, CMS can hold claims for 10 business days. The hold period will begin on April 1 and continue through April 14.

CMS previously said the initial period has minimal impact on physician cash flow because according to law, electronic claims are not paid any sooner than 14 calendar days and paper claims not earlier than 29 calendar days from the date of submission.

CMS will notify physicians on or before April 11 regarding further information about the status of congressional action to avoid the potential cut and next steps.

Primary care physicians can choose to continue charging the 2015 rates for April services or delay submitting claims until after final action is taken on the legislation. If Congress allows the 21 percent cut to take effect, Medicare would pay physicians at the reduced amount regardless of what the physician billed initially and no subsequent action would be necessary.

The MACRA legislation contains other components that benefit primary care, including an extension of full funding for CHIP through 2017. Funding for teaching health centers, community health centers and the National Health Service Corps also would be extended for another two years. The cost of the legislation is about $140 billion, according to an estimate by the Congressional Budget Office.

"While not a perfect solution to health care delivery reform, MACRA resolves some of our health care system's most pressing issues," Wergin said. "It reinforces reliable access to better, more efficient care for elderly and disabled patients, and it preserves health coverage for our most vulnerable children. It continues progress in building the primary care physician workforce that forms the foundation of high-quality health care."