Physician payment formula (SGR) repealed by Congress

Dermatologists were among those breathing a sigh of relief in April when Congress passed the Medicare Access and CHIP Reauthorization Act. The Act permanently ends CMS’s use of the Sustainable Growth Rate (SGR) physician payment formula.

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American Academy of Dermatology (AAD) President Mark G. Lebwohl, M.D., said this in an Academy statement: “The American Academy of Dermatology Association is grateful to Congress for taking a historic, bipartisan step to pass the Medicare Access and CHIP Reauthorization Act. The law ends an era of fixes and patches caused by the …SGR formula that for far too long left Medicare beneficiaries wondering about their ability to access quality dermatological care. With the SGR charade behind us, physicians have an added measure of practice stability that will enable us to more closely focus on meaningful physician payment and delivery reforms that facilitate access to high quality patient care. “

“Dermatology patients can also breathe a little easier today, knowing that the bill also alleviates additional co-pays for surgical or procedural follow-up care. It was unconscionable that under a previously established policy, patients would have to open their wallets to simply have their stitches out. Not only is this bill good policy, it’s the right thing for patients.”

NEXT: Details on a viewpoint in JAMA

Details

According to a viewpoint published in the Journal of the American Medical Association (JAMA) on April 17, 2015, by Robert Steinbrook, M.D., the Medicare Access and CHIP Reauthorization Act of 2015 offers physicians stable fee updates for five years. The Merit-based Incentive Payment System (MIPS) will replace the Physician Quality Reporting System, the value-based payment modifier and the meaningful use of electronic health records payment systems in 2019. Payment rates will be maintained, under MIPS, through 2025, but adjusted up or down depending on each physician’s or healthcare provider’s composite performance score, according to Dr. Steinbrook, professor in the department of internal medicine, Yale School of Medicine.

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While a positive move for now, physicians should not look at the SGR fix as a permanent solution to the uproar associated with the physician payment system and uncertainties about care access, Dr. Steinbrook wrote.

“Until the details of the measures of quality and value and incentive payments become available, it is uncertain if physicians will consider them reasonable and fair,” he wrote.