Top Issues

Massive Pay Cuts Announced by CMS; SGR Must be Repealed

Illustrating the depth of the flawed sustainable growth rate formula (SGR) that sets Medicare physician reimbursement, CMS today announced a 21.2 percent cut in Medicare physician payments effective on Jan. 1, 2010. For years, the AGA has aggressively advocated that Congress fix the flawed SGR formula as part of long-term health-care reform. If the cut goes through, screening colonoscopy payments will decrease from approximately $208 to $164 in 2010. Fortunately, there is a growing understanding in Congress that the SGR needs to be repealed. This week a bill was introduced in the House that would replace the SGR and transition physicians into a new payment model that is more stable and predictable.

Take action — Contact your Lawmakers to urge them to repeal the SGR formula and prevent the 21.2 percent cut from being implemented in January 2010.

About the CMS Rule & Legislation to Repeal the SGR

The AGA is analyzing the final rule and its impact on gastroenterology, and will provide a more in-depth update next week. CMS is finalizing its proposal to stop making payments for consultation codes, despite opposition by AGA and many physician specialties. CMS has also decided to implement the new practice expense survey data from the Physician Practice Information Survey over a four-year time period for all specialties except medical oncology, whose supplemental survey data will continue to be used.

Pay Cut Announced in Final Rule

The final rule will be published in the Federal Register on November 25. Details on the final rule are currently available in a CMS press release and fact sheet. The GI societies provided extensive comments to CMS in our letter on the proposed rule published in July.

H.R. 3961, the Medicare Physician Payment Reform Act

On Oct. 29, 2009, the House leadership introduced H.R. 3961, the Medicare Physician Payment Reform Act, which revamps the current SGR formula by preventing the 21.2 percent cut in payments in January 2010. The legislation also transitions physicians to a new payment system that creates two new targets for physicians: one for evaluation and management services, which would include preventive services, and another target for all other services. The legislation would encourage physicians to form accountable care organizations through which they would be rewarded based on quality and efficiency. The AGA continues to analyze and review this bill and its impact on gastroenterology.

AGA, along with our partners in the Alliance for Specialty Medicine, continue to fight these devastating cuts that will occur next year if Congress fails to repeal the SGR formula or specifically address the 2010 cut.

Also announced today is the final rule for hospital outpatient departments and ambulatory surgical centers. The AGA will provide information on this rule next week.