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Letter to Provider Companies - Sustainable Growth Rate (SGR) Repeal and Reform Proposal


Location: Washington, DC

Leaders of the House Energy and Commerce Committee and Ways and Means Committee today outlined additional details of a proposal to repeal the current Sustainable Growth Rate (SGR) system and replace it with a fair and stable system of physician payment in the Medicare program. On February 7, the committees outlined a framework to reform the current Medicare system that is fiscally responsible and free of politics. The updates released today incorporate feedback received from stakeholders on the initial proposal. The committees are seeking additional feedback on this updated proposal.

In a letter to providers, Energy and Commerce Committee Chairman Fred Upton (R-MI), Ways and Means Chairman Dave Camp (R-MI), Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-PA), and Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) wrote, "Fixing the flawed SGR physician payment system is a top priority for the Committees on Energy and Commerce and Ways and Means. We recognize that the uncertainty over potentially devastating reimbursement cuts makes it difficult for practices to plan for the future. This uncertainty affects decisions to hire necessary staff and make investments in practice improvement."

The latest proposal provides further details and clarity on the three phases outlined in the earlier proposal. The current proposal specifies a process to reward providers for high-quality and efficient care in the fee for service (FFS) program. The proposal also includes processes to determine quality and efficiency measures that focus on evidence while being flexible and specialty-specific; recognizes the role that specialty-specific registries play in facilitating quality improvement while minimizing provider participation burden; and addresses the need for timely performance feedback to allow providers to identify improvement opportunities and optimize incentive payments.

The leaders added, "we envision a system where providers have the flexibility to participate in the payment and delivery model that best fits their practice. The overarching goal is to reward providers for delivering high-quality, efficient health care, whether in a FFS system or in an alternative payment model program."

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