SGR on Way to Extinction: Senate Finance Committee Passes Landmark Bill to Provide Certainty for Medicare Seniors and Physicians

Bill Repeals “Doctors’ Fix” Permanently, Transitions to Streamlined Performance-Based Payment System

Includes Bennet Amendment to Expand Access to Medicare Data, Improve Quality of Care

Colorado U.S. Senator Michael Bennet today joined his colleagues on the Senate Finance Committee to advance a bill that will provide long-term certainty for Medicare providers and patients. The bill repeals the formula, known as the “sustainable growth rate” or SGR, for how Medicare providers are reimbursed for services and replaces it with a streamlined payment system based on the quality of care.

“This bill is a huge step forward from the short-term fixes that have cost taxpayers billions of dollars and serve as nothing more than a temporary bandage,” Bennet said. “Colorado doctors are ready to move towards a more innovative payment system, but they need some stability and a pathway to get there. We’re one step closer to getting this done permanently and in a commonsense way that will benefit doctors and seniors.”

Over the past decade, Medicare physician spending has exceeded the targets set by the SGR, resulting in the need for payment cuts under the formula. In order to avert these cuts and maintain services for Medicare patients, Congress has spent nearly $150 billion on short-term overrides during that time. The Improvements for Medicare Beneficiaries and Physicians Act transitions from the current volume-based payment system to one that rewards quality, efficiency, and innovation.

Bennet’s amendment

Bennet secured a provision in the bill that will expand access to Medicare claims data to help evaluate doctor and hospital performance and find innovative, more effective, and less expensive ways to offer health care to beneficiaries.

The Affordable Care Act already permits certain “qualified entities” access to this data to evaluate and report on the performance of health care providers, however only nine organizations across the United States, including one in Colorado, are currently qualified entities and are extremely limited in their use of Medicare data. Expanding access to the data and the allowable uses will help get a bigger picture of how providers stack up against each other in terms of cost, quality of care, and other factors.

The House Ways and Means Committee passed its version of the bill today in a 39-0 vote.