The U.S. House of Representatives on March 14 approved legislation by a vote of 238 to 181 to repeal Medicare's sustainable growth rate (SGR) formula that would cut the physician reimbursement rate this year by nearly 24 percent. However, Senate passage in its present form is poor because the House included language to delay the Accountable Care Act's individual mandate for five years.

If enacted into law, the legislation would avert a 23.7 percent payment cut starting April 1. Under a new payment formula, physicians would receive an annual update of 0.5 percent from 2014 through 2018, with the rates in 2018 maintained through 2023. Physicians, however, could receive incentive payments during that time. Starting in 2014 and ongoing thereafter, physicians participating in alternative payment models would receive an annual update of one percent while others would continue at the 0.5 percent rate.

“This is a bipartisan pay-for. It has passed the floor of this House in a bipartisan fashion. It is ready to go. We call upon our colleagues in the other body, ‘Use whatever Senate procedures you need to, but get this done because the clock is ticking,’” said Rep. Michael C. Burgess, M.D. (R-Tex.).

The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 was introduced last month by a bipartisan group of House and Senate members to repeal a "flawed" SGR formula and to streamline incentive payment programs by consolidating the Physician Quality Reporting System, the Value-Based Payment Modifier, and Meaningful Use EHR incentive program into one program that increasingly rewards quality and value.

“This bill will provide doctors who treat Medicare patients with certainty, incentivize and reward doctors to keep seniors healthy with better care," said Rep. Gus Bilirakis (R-Fla.) on the floor of the House.

Starting in 2018, a new Merit-Based Incentive Payment System (MIPS) program would assess the performance of eligible professionals (EPs) in four categories: quality, resource use, EHR Meaningful Use and clinical practice improvement. Under MIPS, EPs would potentially receive both positive and negative payment adjustments based on their overall performance in the four categories.

MIPS would apply to the following types of professionals: doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatric medicine, doctors of optometry, chiropractors, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. Other professionals paid under the physician fee schedule may be included in the MIPS beginning in 2020.

Text of the House-passed bill, H.R. 4015 (engrossed version) is avaialable at congress.gov.

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