MPPR, CDS Get Attention in New Bill to Repeal SGR

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On Wednesday, July 31, the House Energy and Commerce Committee voted 51-0 in favor of a package that would repeal the Sustainable Growth Rate (SGR) formula for determining Medicare reimbursement. HR 2810 is likely to be used as a framework by the House Ways and Means Committee for developing more comprehensive SGR legislation, according to Ted Burnes, director of RADPAC.

The bill also included a last-minute addition that will be music to the ears of the radiology community: the requirement that the Centers for Medicare and Medicaid Services (CMS) provide data justifying the multiple procedure payment reduction (MPPR) implemented in 2012 and expanded in 2013. The language states:

“The Secretary of Health and Human Services shall make publicly available the data used to establish the multiple procedure payment reduction policy to the professional component of imaging services in the final rule published in the Federal Register.”

No timeframe was established, but the inclusion of language surrounding the MPPR and its economic justifiability is valuable because it gets the issue on the radar of legislators going into the final months of 2013, Burnes says.

“The MPPR portion of the bill has bipartisan support and is budget-neutral, which makes it difficult to get rid of,” he notes. “It is our hope that in asking CMS to justify the 25% cut, we will establish a platform for future discussion with them regarding a more appropriate payment reduction for multiple procedures based on our understanding of the potential efficiencies.”

Also included in the 32-page amendment to the Energy and Commerce package was language surrounding the use of clinical decision support (CDS), for which the ACR, with the support of the American Medical Association, has been advocating as a tool to curb inappropriate imaging. The language states:

“Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report on the extent to which clinical decision support mechanisms and other provider support tools could be used to further program objectives under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) and recommendation for how such mechanisms and tools should be so used.”

Ultimately, Burnes expects to see the SGR—and, with any luck, the MPPR and CDS along with it—addressed in the debt ceiling package, which could be extended from October to the end of the year. “This is a great first victory in a long process,” he says. “The fact that we are the only physician specialty group to have any kind of policy-oriented language included in the bill is promising.”