SGR fix in the works as CBO again cuts price tag

The Congressional Budget Office (CBO) announced it has again cut its estimate for repealing the sustainable growth rate (SGR). The updated forecast may make it easier for Congress to pass SGR repeal legislation before it adjourns for the year on December 13.

CBO's own estimate for abolishing the SGR is now $116.5 billion over the next 10 years, down from its February prediction of $139 billion. Cuts of 24% to overall physician payment rates will go into effect in 2014 unless Congress repeals the SGR or passes yet another short-term fix.

CBO also calculated that the cost of HR 2810, the Medicare Patient Access and Quality Improvement Act, would be $153.2 billion -- about $20 billion less than its previous prediction of $175 billion. HR 2810 was approved in July by the House Energy and Commerce Committee's subcommittee on health.

"Fixing the flawed Medicare payment formula is some of the most important work facing this Congress," said Rep. Dr. Michael Burgess (R-TX), vice chairman of the subcommittee, in a statement. "The committee's legislation to repeal the SGR is vital to protect the health of our seniors and ensure that our nation's best doctors continue to see Medicare patients. I am certain that this new estimate by the CBO will accelerate the pace in passing this bill."

HR 2810 seeks to accomplish three primary goals: to provide physicians with a period of budgetary certainty, to develop a modified fee-for-service system, and to accelerate movement toward reimbursing physicians through alternative payment models, according to the American College of Radiology (ACR).

"It is important to note that the Energy and Commerce Committee decided not to outline how Congress plans to cover the cost of repealing the SGR," ACR said in a statement. "Instead, the Energy and Commerce Committee elected to develop the key characteristics of the new physician reimbursement system while leaving the decisions over financial offsets to both the House Ways and Means and Senate Finance Committees."

The Senate Finance Committee plans to mark up its own version of SGR repeal legislation on December 12, and the House Ways and Means Committee may address it as well, according to ACR. The Senate's bill is estimated to cost approximately $150 billion over 10 years, and like the House, it has not yet specified how this proposal will be paid for, ACR said.

In the meantime, Congress is considering yet another short-term SGR patch of up to three months to give lawmakers time to address a permanent SGR repeal, Cynthia Moran, assistant executive director for government relations at ACR, told AuntMinnie.com.

"There will need to be a short-term fix to buy time for both houses to complete action on a permanent repeal," Moran said. "Therefore, a patch of up to three months will need to pass both houses either before they recess on December 13, or they'll do it in early January, with retroactive payment to the January 1 cut."

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