The SGR is history. Now what?

Right up until the Senate officially sealed the fate of Medicare’s flawed sustainable growth rate (SGR) with a 92-8 vote late Tuesday night, it was easy to see how it all might unravel. The Senate had already pushed the vote back as far as possible due to a two-week recess, concerns about the repeal bill’s cost were becoming more vocal, and six amendments were to be voted on before the final SGR repeal vote.

If any of those six amendments—which included another swipe at the Affordable Care Act’s individual mandate, additional years on the Children’s Health Insurance Program (CHIP) extension already in the bill, and more—had passed, the bill would have had to go back to the House. House leadership had already said it wasn’t going to play ball with any changes to the bill, and Medicare physician payment cuts loomed.

But the amendments all failed, the bill passed, and the SGR was no more.

So now what?

In the immediate aftermath of the Senate’s vote, there was much celebration. And why not? The SGR had been a thorn in the side of physicians and policymakers for years, with no less than 17 temporary patches used to stave off deep cuts to Medicare physician reimbursement while a permanent solution remained politically elusive. Some physician group leaders, though, sought to remind the healthcare community that more work is needed to improve payment delivery systems.

“Previous short-term SGR fixes have too often been paid for out of technical component reductions in diagnostic imaging. It is long past time to put some stability into the physician payment system. However, infinite policy details must be worked out to ensure it is implemented appropriately,” said Bibb Allen, MD, FACR, chair of the American College of Radiology Board of Chancellors, in a statement. “The legislation moves us away from fee-for-service to value-based alternative payment models, most not yet designed, but this is the future and the future is now.”

In a conference call with media, American Medical Association (AMA) executive vice president and CEO James L. Madara, MD, echoed Allen’s comment about making sure the provisions in the SGR repeal bill—which provide annual 0.5 percent payment updates through 2019 and opportunities for bonus payments beyond that through a consolidation of incentive programs—are implemented properly. Madera said the AMA will keep its finger on the pulse of matters and work with the federal government to make sure the changes track correctly.

He also said the focus on dealing with the SGR had been overshadowing work being done to improve payment delivery through the development of new models, and that a brighter light will now shine on these other elements.

“We can shift to working with all levels of government toward policies that allow access to affordable quality care, lower health costs, and with the SGR behind us, we can now work toward those other elements with Congress, CMS and others,” said Madara.

The repeal bill rolls the Meaningful Use program, Physician Quality Reporting System and Value-Based Payment Modifier into one new program, called the Merit-Based Incentive Payment System. Meanwhile, accountable care organizations continue to spread and mature, and value will remain the goal at every institution looking to thrive. There are many developments on the horizon.

It’s a brave new SGR-free world.

-Evan Godt
Editor – Health Imaging