Last week the U.S. House of Representatives by an overwhelming margin passed the SGR repeal legislation, H.R. 2, the "Medicare Access and CHIP Reauthorization Act." Three of the four Kansas lawmakers, Reps. Lynn Jenkins, Kevin Yoder and Mike Pompeo voted for the bill, while Rep. Tim Huelskamp voted against the bill. Despite reservations about certain aspects of the bill, KMS supported it because it likely represents the best opportunity in years to repeal the flawed SGR payment formula.

In addition to repealing the SGR formula, the bill provides stable payment updates of .5 percent for five years and ensures no changes are made to the current payment system for four years. Also, beginning with 2019, it consolidates the three existing incentive payment programs into a new Merit-Based Incentive Payment System (MIPS). The MIPS will replace the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VBM) that adjusts payment based on resource use and meaningful use of EHRs (EHR MU) that entails meeting certain requirements in the use of certified EHR systems. The payment penalties associated with failing to report quality measures in PQRS (-2 percent) and failing to meet EHR meaningful use goals (-3 percent) will sunset at the end of 2018. It also provides financial incentives to encourage physicians to participate in alternative payment models (APMs).

The U.S. Senate will vote on the bill when senators return from a two week recess on April 13. The current SGR patch expired April 1, but the federal government has once again instructed its Medicare carriers to hold claims for services provided after that date until the Senate can act on the bill, which reverses the 21 percent cut under the SGR formula.

Among the many provisions in the bill were the following of particular interest:
The Medicare quality guidelines and measures cannot be used to establish the standard of care in a medical malpractice claim.

• The work GPCI floor was extended through 2017.
• The Children's Health Insurance Program (CHIP) was extended through 2017.
• The CMS plan to eliminate bundled payments for 10-day and 90-day global surgical services has been reversed; instead, CMS will collect data on these services beginning in 2017 to determine the accuracy of payment rates.
• Physicians who opt-out of Medicare may automatically renew at the end of each two year cycle.
• A requirement that Electronic Health Records (EHR) be interoperable by 2018 and prohibits providers from deliberately blocking information sharing with other EHR vendor products.

If you have questions about the legislation, contact Ruth Cornwall at This email address is being protected from spambots. You need JavaScript enabled to view it..