MSNJ 2013 SGR Reform Toolkit December 2, 2013 John Poole, MD MSNJ Treasurer AMPAC Chair

Congressional Action –Part 1  The House Energy and Commerce Committee passed H.R. 2810, the Medicare Patient Access and Quality Improvement Act of  H.R was approved by the health subcommittee on July 23, 2013 and passed the full committee by a 51-0 vote on Wednesday, July 31,  Under the bill, the SGR would end after From 2014 to 2018, the update would be 0.5 percent per year. In the years from 2019 and beyond, the 0.5 percent annual update would continue, with incentives and potential penalties under the new Quality Update Incentive Program.

Congressional Action –Part 2  At the end of October, the Senate Finance Committee and the House Ways & Means Committee released a draft proposal that would also permanently repeal the Medicare SGR formula. This proposal would replace it with payment reforms that reward quality through alternative payment models (e.g. ACOs). This new proposal does NOT include positive updates, but rather flat rates.  The AMA and others have submitted comments urging the inclusion of positive updates.  Senate Finance Committee Chairman Max Baucus (D-MT) announced this month an Open Executive Session on December 12th at 10am E.T. to discuss SGR repeal, so we have another opportunity to weigh in.

AMA Interim Meeting Action  Following robust discussion earlier this month in various caucuses, open forums, and in Reference Committee, the House of Delegates passed an amended version of Resolution 226 regarding repeal of Medicare’s sustainable growth rate (SGR) physician payment update formula.  In addition to reaffirming relevant AMA policy, the resolution directed the AMA to support SGR repeal and to continue its strong advocacy for positive updates and for its pay-for-performance principles and guidelines.  Further, the AMA was directed to advocate with the Centers for Medicare and Medicaid Services and Congress for alternative payment models to be developed in concert with specialty and state medical societies.  The final text can be viewed on pages of the annotated Reference Committee B report at: assn.org/assets/meeting/2013i/i13-refcommb-annotated.pdfhttp:// assn.org/assets/meeting/2013i/i13-refcommb-annotated.pdf

MSNJ Priorities for SGR Reform  Positive base payment updates during transition;  Changes in the proposed value-based purchasing program to reflect medical principles and guidelines;  Flexibility for smaller practices, including a more equitable structure of performance comparisons, added financial and technical assistance, and an exemption for physicians nearing retirement;  Capping penalties for non-reporting to a limited amount;  Alternative payment model (APM) provisions, including multiple pathways to achieving various thresholds and for specialists to develop and obtain approval for new models.

CMS Action  CMS adopted its final rule on the 2014 Medicare Physician payment schedule on November 27. It is available at:  The net reduction in payment rates will approach 24% if Congress does not act.

Call to Action  Template letter to Congress members  More information at the MSNJ website:  AMA’s campaign:  Earlier this month, Representatives Bill Flores (R-TX) and Dan Maffei (D- NY) released their congressional sign-on letter to the House leadership urging that the SGR be repealed this year. The letter was signed by 259 Members of Congress (141 Republicans and 118 Democrats). Only 5 of 12 members of New Jersey’s delegation signed on:  Rep. Rush Holt (NJ-12), Rep. Leonard Lance (NJ-07), Rep. Bill Pascrell (NJ-09), Rep. Donald Payne (NJ-10), Rep. Albio Sires (NJ-08)  New Jersey delegation contacts:  See this link for support from other organizations: medicare-physician-payment-reform-proposal medicare-physician-payment-reform-proposal