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Over the past few months there has been a lot of activity on the SGR front, and the AANS and CNS have been at the forefront of discussions on the best way to fix Medicare’s flawed sustainable growth rate (SGR) payment formula. Neurosurgery is urging Congress to incorporate the following elements in any SGR replacement legislation:

  • Repeal the SGR and include at least a five-year period of stability, with positive updates during the transition period and each year thereafter based on the Medicare Economic Index (MEI);
  • Adopt flexible criteria that allow physician participation in delivery and payment models that are meaningful to their practices and patient populations, including preserving a viable fee-for-service option and recognizing the value of clinical data registries for improving quality;
  • Avoid payment differentials between primary care physicians and specialists;
  • Base any quality-related payments on positive incentives, rather than penalties, and prevent physicians from being evaluated based on flawed ranking systems or head-to-head comparisons;
  • Encourage physician-led quality improvement that allows the medical specialty societies to determine the most appropriate and clinically relevant quality improvement metrics and strategies for use in future quality initiatives;
  • Replace the current Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) and Value-Based Payment Modifier (VBPM) programs and penalties;
  • Establish legal protections making it clear that the development, recognition, or implementation of any guideline, quality improvement program or other payment standard under Federal healthcare law does not establish a new standard of care in any medical malpractice claim;
  • Allow patients and physicians to privately contract on a case-by-case basis, with beneficiaries receiving the Medicare allowable; and
  • Repeal the Independent Payment Advisory Board (IPAB).

As previously reported, on July 31, 2013, by a vote of 51 to zero, the House Energy and Commerce Committee unanimously passed H.R. 2810, the Medicare Patient Access and Quality Improvement Act.  Attention is now turned to the Senate Finance and House Ways and Means Committees, which are currently developing their own SGR legislation.

AANS and CNS Washington Office staff have met with committee staff, and with the individual members of Congress who serve on these committees, to promote our principles for reform. In addition, neurosurgery recently led an effort to send a letter to the and Committees. In this letter, signed by 23 state medical and national specialty societies, we called for the repeal of the SGR, physician-driven quality measurement, patient-shared billing, and medical liability reform. Finally, on Sept. 19, 2013, the AANS and CNS teamed up with the Alliance of Specialty Medicine in sending a to House and Senate leaders stressing the importance of fixing the current Medicare payment system by eliminating the SGR. In the letter, we urged that replacement of Medicare’s flawed SGR reimbursement formula needs to remain a top priority for action this year as physicians face significant cuts which could impede patient access to care.

As the SGR developments continue to evolve, the AANS and CNS will continue to advocate aggressively on behalf of neurosurgeons to ensure that they can continue to provide timely, compassionate, high quality and state-of-the-art treatment for patients in need of neurosurgical care.

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