The sustainable growth rate (SGR) is a formula intended to reduce Medicare spending by cutting payments to providers. Since the law was enacted in 1997, Congress has passed short-term fixes that keep the SGR from going into full effect.
ANA supports repealing the Medicare SGR formula and reforming Medicare Part B payment. With Congressional action on the SGR underway, ANA submitted letters to members of the House Energy and Commerce (E & C) Committee representing the interests of more than 100,000 advanced practice registered nurses (APRNs) who directly bill Medicare Part B carriers that provide services to more than 10 million Part B fee-for-service beneficiaries. The 27% SGR cut to providers would have a huge impact on physician and APRN practices throughout the country, which in turn would negatively impact patients’ access to care.
Earlier this year, the Congressional Budget Office announced that due to a decrease in Medicare spending, cost of the SGR has been reduced from $244 billion to $175 billion. Congressional leaders want to address the problem now because it has a lower price tag.
On July 31, the Medicare Patient Access and Quality Improvement Act (H.R. 2810) was unanimously approved by the House E & C Committee. According to the committee, H.R. 2810 seeks to make numerous policy changes in three phases. (See Three phases of H.R. 2810 by clicking the PDF icon above.)
The plan starts with repeal of the SGR and a 5-year period of payment stability for providers. The reimbursement rate would grow 0.5% under the plan between 2014 and 2018. After that, providers could report certain quality measures, which would be compared to measures reported by others. Traditional fee-for-service payments could be adjusted based on the results.
Medical specialty societies will develop meaningful measures and clinical improvement activities using a standard process. The committee adopted a bipartisan amendment, offered by Reps. Burgess (R-TX) and Pallone (D-NJ), which addresses APRN issues. It clarified a critical definition to include APRNs among stakeholders authorized to contribute to and participate in clinical improvement and quality-measures development, evaluation, and implementation.
The amendment also extended authorization for nurse practitioners (NP) and physician assistants to bill Medicare for complex chronic-care coordination services. The original bill restricted billing of such services to medical doctors and doctors of osteopathy. Reps. Capps (D-CA), Ellmers (R-NC), and McKinley (D-WV), among others, spoke in favor of the Section 4 (H.R. 2810) NP provision.
Although Congress has made some progress, there is much more work ahead for healthcare associations and members of Congress as H.R. 2810 moves to the House Ways & Means Committee and the Senate Finance Committee for consideration. It has been reported that the Finance Committee plans to draft its version of SGR reform, a so-called “doc fix” bill. The bipartisan support shown in the House E & C Committee could evaporate quickly as the discussion turns to how to pay the $175 billion price tag of repealing the SGR.
ANA has sent several letters to the House E & C Committee as well as the Senate Finance Committee, and will continue to monitor the progress and comment where necessary. To keep informed or take action, visit RNaction.org.
Resources: Medicare Patient Access and Quality Improvement Act: http://energycommerce.house.gov/sgr. Letter to House E & C Committee, July 30, 2013: http://nursingworld.org/DocumentVault/GOVA/Federal/Testimonies/SGR-Testimony.pdf
April Canter is an associate director in the Department of Government Affairs at the American Nurses Association.