Subject: SGR Repeal and Medicare Provider Payment Modernization Act
Dear Senators Wyden and Hatch and Representatives Camp, Levin, Upton, Waxman and Burgess:
On behalf of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological
Surgeons (CNS), we wish to again express our sincerest appreciation for all your hard work to develop
legislation to repeal and replace Medicare’s sustainable growth rate (SGR) physician payment formula. We
realize that it has been a tremendous undertaking to balance the various interests of policymakers,
stakeholders and healthcare thought leaders, and we commend you for your efforts. Because it meets
many of our core principles, the AANS and CNS offer our support of the SGR Repeal and Medicare
Provider Payment Modernization Act (S. 2000/H.R. 4015). We encourage Congress to identify acceptable
offsets and pass this legislation before the expiration of the current SGR patch.
Specifically, the SGR Repeal and Medicare Provider Payment Modernization Act reflects the following
principles, which we believe are essential elements of physician payment reform:
- Repeals the SGR and provides physicians with a five-year period of payment stability and positive
updates; - Consolidates the current Physician Quality Reporting System (PQRS), Electronic Health Record
(EHR) and Value-Based Payment Modifier (VBPM) programs and eliminates the penalties
associated with these programs; - Provides physicians a choice of payment models, including fee-for-service;
- Includes positive incentives for quality improvement payment programs that allow all physicians the
opportunity to earn bonus payments; - Enhances the ability of physicians, rather than the government, to develop quality measures and
clinical practice improvement activities; and - Clarifies that quality improvement program requirements do not create new standards of care for
purposes of medical malpractice lawsuits.
Although the legislation certainly incorporates many of our recommendations, we continue to have ongoing
concerns about several aspects of the bill, which may adversely affect Medicare beneficiaries’ access to
specialty care.
First, while we recognize that Congress is working within difficult fiscal restraints, we are disappointed that
the bill does not include annual positive base payment updates. Over the next decade, medical practice
costs, as measured by the Medicare Economic Index (MEI), will exceed 25 percent, and under this bill
physicians will continue to lose ground to inflation — and this is on top of the past decade of flat Medicare
payments.
Additionally, we believe the misvalued code section is unnecessary. To provide Medicare with reliable data
on how physician work has changed over time, the Relative Value Scale Update Committee (RUC), with
more than 300 experts in medicine and research, is examining more than 1,500 potentially misvalued
services accounting for over $38 billion in Medicare spending. Already the RUC has recommended
reductions to more than 600 services, redistributing more than $3 billion, and this work continues.
Unfortunately, the targets set in the legislation are arbitrary, and, given the significant cuts to specialty
services resulting from the current ongoing review, it will be difficult to achieve an additional $1 billion in
redistributive cuts. Regardless, this section basically negates the modest 0.5 percent update for three of
the five years during the transition period to the new quality incentive payment program.
Finally, we very much appreciate that this version of the legislation is structured in such a manner that all
physicians have an opportunity to earn quality incentives and avoid quality-related penalties, with the
highest performing physicians receiving additional bonus payments. Nevertheless, because there is a finite
amount of money available for quality incentive payments, we are concerned that many physicians will still
receive penalties, rather than bonuses. We therefore encourage Congress to exercise ongoing oversight
over the merit-based incentive payment system (MIPS) to ensure that the performance metrics employed
are in fact reflective of the views of the medical profession and the scoring system is fair and accurate.
Once again, we thank you for your efforts to replace the SGR formula with a more sustainable physician
payment system. If you have any questions, please don’t hesitate to contact us.
…
Read full letter here
