Senate passes SGR bill 92 to 8, avoids April 15 payment cuts

Photo of Russel Senate Office Building from Wikipedia.

Closing in on two hours before the midnight deadline, the U.S. Senate on Tuesday in a vote of 92 to 8 passed the bill to permanently end the sustainable growth rate formula that threatened to cut physician Medicare reimbursement by 21 percent.

President Barack Obama has said he would sign the bill. Senate Finance Committee Chairman Orrin Hatch, R-Utah, urged bipartisan support.

Senators initially voted on six amendments and all failed except one, a motion to waive the budget rules to add billions to the deficit in passing the bill.

The bill ends years of “doc fixes” to stop mandatory physician pay cuts from taking effect under a SGR formula for controlling costs, a measure most agreed never worked.

The Senate voted the night before the Centers for Medicare and Medicaid Services planned to reduce physician reimbursement by 21.2 percent, as mandated by SGR.

The House in late March overwhelmingly approved the H.R. 2 bill to replace the sustainable growth rate. The pressure went to the Senate, which recessed for two weeks prior to debating the bill this week. The SGR fix moves Medicare reimbursement further in the direction healthcare of value-based reimbursement over fee-for-service.

The bill adds an estimated $141 billion to the deficit, as the Congressional Budget Office has warned.

Five amendments failed Tuesday.

Sen. John Cornyn, R-Texas, called for amendment for a deficit-neutral bill that failed. Sen. Ron Wyden, D-Oregon, called the amendment a “death spiral for affordable healthcare.” A proposed amendment to add two years of funding to CHIP, failed in a vote of 50 in favor and 50 against, with three-fifths vote needed, even though the House bill included CHIP funding. Sen. Tom Cotton, R-Arkansas, wanted an amendment to keep indefinitely a physician bonus of .5 percent. It failed in a vote of 11 in favor, and 89 against.

Sen. Patty Murray, D-Washington, asked for an amendment to add two additional years for community funding from the two proposed. Opponents said the bill would add $21.1 billion to the deficit. The proposed amendment failed, with 57 “no” votes. Sen. Ben Cardin, D-Maryland, proposed an amendment for access to therapy services beyond the therapy cap in the bill, a proposal that failed 58 votes to 42, with a three-fifths vote needed.

What the bill does do is aim to transition Medicare to a comprehensive value-based health program.

It replaces the current reimbursement schedule with payment increases for doctors for the next five years as CMS develops a new payment system focused “on quality, value and accountability.” The various existing payment incentive programs would be combined into the “Merit-Based Incentive Payment System." A “technical advisory committee” will be tasked with recommending aspects of the alternative payment models and measures of  quality of care that will be used to reward or penalize physicians.

Hospital and physician groups praised the bipartisanship and ideas in the bill, but also added that work remains to be done.

“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians — facilitating the implementation of innovative care models that will improve care quality and lower costs,” said James Madara, MD, CEO of the American Medical Association. “Patients will be able to get the care they need and deserve.”

Twitter: @SusanMorseHFN