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The Road to SGR Repeal

April 16, 2015 was a historic day for the physician community, as President Obama signed H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA)—the last step in the long road to permanently repealing the flawed Sustainable Growth Rate (SGR) physician payment formula. This landmark legislation was passed in both the House (392-37) and Senate (92-8) with solid bipartisan majorities. The legislation includes provisions addressing several of the AAO-HNS’ legislative priorities, including:

• Permanent repeal of the flawed Sustainable Growth Rate (SGR) formula used to determine payments to physicians under the Medicare program;

• Rescission of the new CMS policy to transition all 10- and 90-day global payment codes to 0-day codes by 2018; and

• Consolidation of performance-based programs (PQRS, VBM, and EHR MU) into a unified Merit-Based Incentive Payment System (MIPS).

The AAO-HNS is prepared to work with the Centers for Medicare & Medicaid Services and Congress, if necessary, to ensure the new payment policies set forth in H.R. 2 are implemented as intended.

Click here to review a section-by-section summary of H.R. 2.

Click here to review a summary of the payment provisions included in the bill.

This major legislative victory is the result of years of unrelenting advocacy from the medical community, and tireless grassroots involvement from our members—especially over the last month. Thank you to the AAO-HNS members who acted on the Academy’s “Call to Action” and contacted their Members of Congress. Your voice was heard! 

2013-2014 Congressional Activity on Permanent Repeal of SGR Formula

In February, leaders from three Congressional committees released a bipartisan, bicameral agreement on legislation to permanently repeal the flawed Sustainable Growth Rate (SGR) payment formula and replace it with a new Medicare payment system that better incentivizes the delivery of high-quality, efficient healthcare. See below for relevant resources and updates.

  • On April 1, 2014 President Obama signed H.R. 4302, legislation providing a one-year SGR "patch." 
  • On March 31, 2014 the Senate voted 64-35 to pass H.R. 4302, which would provide a one-year SGR "patch." 
  • On March 27, 2014 the House voted by a voice vote to pass a one-year SGR "patch." Unfortunately, a "voice vote," rather than the typical "roll call vote," prevents the public from knowing each legislator's respective position on the proposal. The Senate is expected to consider the one-year delay later today.
  • On March 26, 2014, Congressional leaders announced their intention to move forward with a 12 month SGR patch, with votes scheduled for Thursday, March 27. The AAO-HNS and others in the physician community are opposed to yet another temporary solution to the ongoing SGR issue and sent letters to leaders in the U.S. House of Representatives and U.S. Senate urging them to focus their collective efforts on negotiating a pathway for enactment of the policy originally introduced as H.R. 4015/S. 2000.
  • View the surgical coalition letter opposing H.R. 4302. 
  • View the letter signed by more than 90 national and state medical societies opposing H.R. 4302. 
  • On March 14, 2014, the U.S. House of Representatives passed an amended version of H.R. 4015 by a vote of 238-181. The amendment included a delay of the ACA individual mandate to fund the SGR policy changes. This offset is not expected to be voted upon or accepted by the U.S. Senate, and the President has signaled his opposition. However, a vote on SGR repeal (including a TBD offset) has been scheduled for the week of March 24, 2014 in the U.S. Senate.
  • The AAO-HNS joined other surgical groups in sponsoring a full-page ad in Politico – a Capitol Hill newspaper. View the ad urging continued bipartisanship by Congressional leaders!
  • View the surgical coalition letter urging Congressional leaders to abandon partisan politics and work toward the development of bipartisan offsets for pending SGR repeal legislation (H.R. 4015/S.2000).
  • View the AAO-HNS letter to Congress in support of H.R. 4015/S. 2000.   
  • View the AMA-sponsored coalition letter with more than 600 physician groups (including the AAO-HNS and nearly 30 state and local OTO societies) supporting the repeal of the SGR formula. 
  • View letter in support of H.R. 4015/S. 2000, signed by 17 Surgical Coalition members (including the AAO-HNS).
  • View a section-by-section Committee analysis of the SGR repeal legislation. 
  • View a one-page Committee summary of the SGR repeal legislation. 

AAO-HNS Comments on SGR Repeal Proposals 
In early 2013, Congressional leaders identified repeal of the flawed Sustainable Growth Rate (SGR) formula as a top legislative priority. Since then, Congressional committees with jurisdiction over Medicare policy have spent substantial time developing legislation that would repeal the flawed SGR formula and replace it with a new payment system that better incentivizes the delivery of high-quality, efficient healthcare. As an active participant in this process, the AAO-HNS has submitted seven comment letters highlighting the possible impact of various proposals on otolaryngology-head and neck surgery and offering suggestions for improving the legislative proposals. The AAO-HNS continues to work closely with key committees while this important effort continues to evolve. Members interested in receiving updates should bookmark this web page or follow the Government Affairs team on Twitter @AAOHNSGovtAffrs. 

  • On December 12, 2013, the House Ways & Means Committee unanimously (39-0) advanced an amended version of H.R. 2810. On the same day, the Senate Finance Committee passed a similar framework by a voice vote and followed their initial activity with the introduction of formal SGR-related legislative language on December 19, 2013. 
  • The House Energy & Commerce Committee previously passed (51-0) H.R. 2810 on July 31, 2013. 
  • View our December 10, 2013 letter to the House Ways & Means and Senate Finance Committees outlining necessary changes to SGR repeal framework. 
  • View our November 12, 2013 comments to the House Ways & Means and Senate Finance Committees regarding their framework to repeal the SGR. 
  • View our comments to the House Energy and Commerce Committee from July 11, 2013. 
  • View our comments to the House Energy and Commerce Committee from June 10, 2013.
  • View our comments to the Senate Finance committee on May 29, 2013.
  • View our follow-up comments to the House committees from April 24, 2013.
  • View our initial comments to the House committees on February 26, 2013.