Congress moved a step closer to eliminating the flawed Sustainable Growth Rate (SGR), with key House and Senate committees formally considering legislation entitled, the SGR Repeal and Medicare Beneficiary Access Act of 2013.

On Dec. 12, both the Senate Finance and House Ways and Means Committees held respective “mark-ups” of bipartisan, bicameral legislation that seeks to repeal the current antiquated system of physician reimbursement in favor of a new process that, among other things, links Medicare payment to the value of care delivered to patients rather than the number of services administered to individuals.

Mark-ups describe the formal process of Senators and Representatives serving on a specific committee to debate and amend bills within their jurisdiction prior to voting either in favor or against the legislation in question. In addition to addressing the SGR, the legislation includes an entire section mandating expanded use of imaging-specific appropriateness criteria by ordering physicians who treat Medicare patients.

This important section, which seeks to modernize and revolutionize the specialty of radiology, came as a result of the tireless efforts of American College of Radiology’s (ACR) physician leaders and members working in tandem with the College’s government relations staff.

The ACR formally supports the SGR Repeal and Medicare Beneficiary Access Act of 2013 and will continue to work with the House and Senate committees to ultimately enact this legislation once Congress returns from its Christmas recess in January 2014.

Lawmakers do not anticipate scheduling a vote in the full House and Senate on the final passage of the bill to permanently repeal and replace the SGR until sometime next year.

In the interim, Congress is expected to pass the Pathway for SGR Reform Act of 2013, legislation that provides a 0.5 percent update to Medicare physician reimbursement rates for an additional three months.

Absent of this short-term extension, all physicians, including radiologists, faced the prospect of a 24 percent cut in Medicare reimbursement rates beginning on Jan. 1, 2014, as mandated by the flawed SGR formula. The cost of avoiding this SGR cut was offset by the imposition of a site neutral payment policy for certain long-term care hospitals, a one-year extension of cuts for Medicaid funding to disproportionate share hospitals initially imposed through the Patient Protection and Affordable Care Act and an increase in the Medicare sequester starting in 2023.

To help ensure passage of the three-month SGR “patch,” lawmakers used a classic Washington Beltway maneuver by attaching the Pathway for SGR Reform Act of 2013 to bipartisan, bicameral legislation addressing the federal budget. Following the October shutdown of the federal government, lawmakers agreed to form a bicameral budget conference committee in hopes of forging a compromise on federal spending levels in Fiscal Years 2014 and 2015. Chaired by Representative Paul Ryan (R-WI) and Senator Patty Murray (D-WA), the budget conference committee unveiled its agreement Wednesday, Dec. 10. Lawmakers added the Pathway for SGR Reform Act of 2013 as an amendment to the budget bill later that day.

The House formally voted on Dec. 11 in favor of the budget conference agreement. It includes the temporary SGR legislation. The Senate is expected to vote on the budget agreement some time during the week of Dec. 16.

The ACR applauds Congress for taking the proactive step of ensuring physicians are not subjected to draconian SGR payment cuts while simultaneously continuing their work on legislation to permanently repeal and replace the current system of Medicare reimbursement. The College also applauds lawmakers for rejecting cuts to radiology reimbursement to finance the temporary SGR patch.

The release of the SGR Repeal and Medicare Beneficiary Access Act of 2013 marks the culmination of months of bipartisan, bicameral work between the Senate Finance and House Ways and Means Committees. The ACR worked closely with staff on both committees holding numerous meetings and filing several rounds of formal comments on the legislative proposal.

The ACR remains bullish about the prospects of Congress finally passing legislation to repeal and replace the SGR, especially following the Congressional Budget Office’s (CBO) recent announcement that the cost of eliminating the formula is now only estimated to be between $116 and $149 billion over 10 years. Previous CBO analyses pegged the 10-year cost of repealing the SGR at about $300 billion.

ACR members are encouraged to closely monitor the College’s website and the Advocacy in Action newsletter for up-to-the-minute news related to the SGR Repeal and Medicare Beneficiary Access Act of 2013.