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Special SDCMS “News You Can Use” <> It's Finally Over: The SGR Is Dead!

Thursday, April 16, 2015

After a decade of battling, the U.S. Senate, in a whopping vote of 92–8, passed HR 2 on Tuesday, the monumental, bipartisan Medicare SGR Payment Reform and Children’s Health Insurance Program (CHIP) Reauthorization Act — both Senators Feinstein and Boxer voted in the affirmative. Two weeks ago, the U.S. House of Representatives adopted the legislation in a landslide vote of 392–37.

A 21% cut to physicians’ Medicare payments was set to take place on April 15. Instead, HR 2 provides positive annual payment updates of 0.5% starting July 1 and lasting through 2019. As well, claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21% cut was scheduled to take effect.

SDCMS and CMA extend a sincere thank you to all member physicians for the extraordinary campaign this last decade to end the SGR. Member physicians kept up the fight these last two years to hold Congress’s feet to the fire to develop a comprehensive bill to reform Medicare physician payments. The unity within organized medicine finally put this over the finish line. Moreover, 52 out of 54 members of the California congressional delegation voted to support physicians — a direct result of long-term SDCMS and CMA advocacy.

Following is a brief summary of the major provisions of HR 2:

  • Repeals the SGR. Obviates in perpetuity the pending 21% across-the-board Medicare cut.
  • Provides 0.5% increases in Medicare each year for four years.
  • In 2019, physicians can choose to participate in one of two payment track options: 1) Maintains a Fee-for-Service Track that simplifies and consolidates the existing quality reporting programs, reinstates large bonuses up to 9% and reduces current penalties; 2) The Alternative Payment Model Track provides 5% bonus payments and allows physicians to develop the new models, such as primary care / specialty medical homes.
  • Physicians will be involved in defining quality.
  • $125 million in funding to help small practice physicians transition to the alternative models or quality reporting programs.
  • Reinstates bundled payments for the 10-day and 90-day global surgical services.
  • Provides total cost of care data to help physicians better manage their practices.
  • Mandates interoperability of EHR systems.

While many will claim credit (JFK’s apocryphal comment “victory has 100 fathers while defeat is an orphan” comes to mind), let there be no doubt that SDCMS-CMA MEMBER PHYSICIAN DUES DOLLARS made this work. Combine this huge SGR win with the victories on Proposition 46, GPCI, arresting the Medi-Cal cuts for three years, preventing any Medi-Cal clawbacks, stopping scope of practice expansions … the list could go on … and the message could not be any clearer: Non-member physicians have received significant value from member dues; please join your fellow physicians who have contributed to these successes by becoming an SDCMS-CMA memberclick here to join now!

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