AMA Presses for Permanent SGR Fix During Congress’s Lame-Duck Session

The American Medical Association is pressing Congress to pass a permanent fix for how Medicare reimburses physicians during the lame-duck session that begins this week.

AMA President Robert Wah in a Nov. 10 blog post said the lame duck session “is a perfect opportunity to end the broken cycle of temporary patches” to the sustainable growth rate (SGR) formula. Without any action, Medicare payments to doctors would be reduced by 21 percent in 2015, although Congress has passed temporary patches every year to avoid similar cuts. A bipartisan agreement on a permanent fix (H.R. 4015) passed the House in March but not the Senate (51 HCDR, 3/17/14), when lawmakers couldn’t agree on how to pay for it.

The most recent patch will expire March 31, 2015. That fix was signed into law April 1.

“If Congress does not seize the moment to act now during the lame duck session all of the hard bipartisan, bicameral work that went into building that framework will be for naught, and the process of negotiating a solution will start all over again,” Wah said.

The AMA is the latest group to call for a permanent SGR fix during the lame-duck session. A coalition of primary care doctors that includes the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) in September said the previous bipartisan bill contained numerous value-based reimbursement provisions that would reduce health-care costs and improve quality.

Earlier this month, the House GOP Doctors Caucus, led by Reps. Phil Gingrey (R-Ga.) and Phil Roe (R-Tenn.), sent a letter to House leadership, saying negotiations with the Senate to pass H.R. 4015 must continue, so an agreement can be reached this year.

Medicaid Changes

The AMA also recently addressed concerns over states not expanding Medicaid. During its Nov. 10 meeting, it passed a policy to encourage states that aren’t participating in Medicaid expansion programs to develop waivers that support expansion plans “that best meet the needs and priorities of their low income adult populations.”

Further, the AMA encouraged the Centers for Medicare & Medicaid Services to approve waivers that are “consistent with the goals and spirit of expanding insurance coverage.” The policy also urges states to use a transparent process for evaluating the success of their efforts to expand access to care and to report the results annually on their Medicaid websites.

Separately, the AMA also adopted a policy calling for an extension of the Medicaid primary care payment increase that would pay Medicare matching rates to Medicaid primary care providers.

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