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Call for Feedback: Participate in a Brief Survey on SGR Legislation

Posted Wednesday, July 3rd, 2013

AAEM members,

AAEM is committed to giving emergency physicians a voice on Capitol Hill. With the assistance of our lobbying firm, Williams & Jensen, we have been closely following the issue of the Standard Growth Rate (SGR) and now we need your assistance. The House Energy & Commerce and House Ways & Means Committee Republicans have drafted proposed SGR legislation.

The Committee has requested feedback from stakeholders in their legislative process. This is an opportunity to have your voice heard. They have asked that feedback be provided by early next week. They expect many of the stakeholder comments to address the two proposed payment scenarios for the Update Incentive Program that is included in the legislation (see below for summary).

Please take a moment to respond to this brief survey
by Monday, July 8th.


Issue Summary

Current Law

Under the current Medicare Sustainable Growth Rate (SGR) formula, the Centers for Medicare and Medicaid Services (CMS) calculates a target for spending on physician services based on four determinations: 1) estimated changes in physician fees; 2) estimated changes in number of Medicare benficiaries; 3) 10-year average annual percentage change in GDP per capita; and 4) Medicare budgetary changes based on current legislation. When expenditures exceed the SGR, as has been the case over the last decade, payment to physicians under the Medicare program are cut.

As a result of this formula, Congress must act to prevent across the board Medicare cuts to all physicians that generally exceed 20 percent. Without Congressional action, the SGR will trigger cuts of nearly 25 percent starting January 1, 2014. The physician community has long advocated a permanent repeal of the SGR in order to provide greater certainty.

The Administration and Congressional leaders in both parties have proposed replacing the SGR formula with a system that rewards quality of care not volume of care.

For more information on the SGR, please visit the following link: http://www.ama-assn.org/resources/doc/mss/cola_medicare_pres.pdf

House Proposal

The two U.S. House of Representatives Committees with primary jurisdiction over healthcare issues have worked to produce draft legislation that would permanently repeal the SGR and replace it with a fee for service (FFS) payment system that gives financial incentives to providers for the delivery of high-quality care. The most recent draft was released on June 28, and provides significantly more detail than previous proposals.

The draft focuses on two proposed payment scenarios outlined in the legislation, which are referred to as "Update Incentive Programs."

1) The "Threshold" or "Benchmark" Update Incentive Payment Model

2) The Percentile Update Incentive Payment Model

Under each model, providers that participate in the Update Incentive Program will receive a composite score at the end of each performance period, which will then be used to determine their fee schedule update, thus providing a financial incentive for high quality health care delivery in the Medicare program. The higher the update, the more a physician will be compensated for providing services.

The link below provides more information on each payment scenario. Note that the proposed legislative language is only a framework - it leaves to be determined the range of scores or percentile ranks linked to the provider updates.

Because current Congressional proposals would link Medicare payment levels to performance and quality measures, there is a great deal at stake for the physician community. Congress has sought feedback from stakeholders like AAEM because they realize that a uniform set of performance measures will have a varying impact on different specialty groups. That is why your feedback is critical as legislation advances through the House and Senate. We have highlighted several key questions raised by the Committee, and we would like your input on what specific ideas AAEM should be advocating.

Add Your Voice

We have identified questions that are most relevant to emergency physicians. Please take a moment to add your voice and respond via Survey Monkey on these issues.

 Please take a moment to respond to this brief survey
by Monday, July 8th.