ACR Comments on House Republicans' SGR Repeal Draft

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Repealing the sustainable growth rate (SGR) formula and its threatened drastic cuts to Medicare physician payments is something the ACR has long supported, but many questions remain in the draft legislation that keeps the College from giving it its full support, writes ACR Board of Chancellors Chairman, Paul H. Ellenbogen, MD, FACR, in a letter to the House Energy and Commerce Committee’s leadership.

A key question is how the SGR repeal will be paid for. In years past, Congress has cut imaging reimbursement 12 times, and several of these cuts were used to offset the cost of temporary SGR fixes. “ACR strongly urges the Energy and Commerce Committee to reject any cuts in Medicare physician reimbursement services, especially those impacting radiology, as a method for covering the cost of repealing and replacing the SGR.”

The text the Energy and Commerce Committee’s leaders, Representatives Fred Upton (R-) and Joe Pitts (R-), have put forward is their second draft of a proposed bill and like the first version, it also does not get into other meaty questions about how it will all be paid for.

One major practical concern Ellenbogen highlighted in his letter is how, in the absences of the SGR, reimbursement for physicians will be set to keep Medicare costs under control and reward better quality and outcomes at the same time. For example, how long will the proposed stable payments period be and will rates be frozen at current levels? Furthermore, once the period of stable payments ends, where will the money come from to create the incentives for meeting quality metrics in the proposed Update Incentive Program? It the money will come from cutting the reimbursement of low-performing physicians, the program will not incentivize high performers as much as it will punish low performers.

Other practical financial concerns not addressed by the legislation is how the performance of specialists -- and especially subspecialists -- in a referral-based field like radiology with very little direct patient interaction will be measured as there are currently very few quality metrics that apply to them. “Without a sufficient number of measures within this new system, radiologists will have difficulty demonstrating their value in delivering patient care and, as a result, their level of reimbursement will likely be inappropriately lower in comparison to their peers,” Ellenbogen warned in the letter.

He also expressed concern at how much power the Secretary of Health and Human Services would be given in setting the quality measures for the program as currently the “normal rulemaking process is far too insular and leaving an untold amount of authority to the Secretary makes radiologists, and all physicians, vulnerable to poor public policy emanating from the executive branch.”

Not stated in the letter, but expressed on the ACR website, was also the concern that current political realities and a condensed legislative calendar present real obstacles to passing a bipartisan legislative package to repeal and replace the SGR this year. The Committee’s goal was to pass legislation in the House before the August recess, but the bill has yet to be introduced. To avoid the approximately a 24 percent reduction in reimbursement as a result of the SGR formula from going into place next year, a bill must be introduced and pass both the House and Senate in time to make it to the President’s desk for signing before January 1.