SGR reform, Medicaid parity untouched by lawmakers in lame duck session

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Medical societies are dismayed that some of physicians’ top concerns were not addressed during Congress’ lame duck session.

Medical societies are dismayed that some of physicians’ top concerns were not addressed during Congress’ lame duck session. Entering 2015, the status of Medicare’s sustainable growth rate (SGR) and Medicare/Medicaid parity will determine whether physicians will be subject to steep reimbursement cuts.

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“It is regrettable that the 113th Congress is adjourning without completing action on critically important legislation to reform Medicare physician payments and ensure that Medicaid patients will continue to have access to primary care physicians. The new 114th Congress can, and must, do better,” David A. Fleming, MD, MA, MACP, president of the American College of Physicians (ACP) said in a written statement.

The current SGR patch, enacted in April, is scheduled to expire on March 31, 2015. Unless Congress enacts a temporary fix for the 18th time or repeals SGR, physicians could face a 21% cut in Medicare reimbursements. The ACP, along with several other physician groups, has called on legislators to abolish the SGR formula. Patching SGR for nearly two decades has cost taxpayers $170 billion.

Fleming says the ACP is “redoubling our efforts” to ensure an SGR repeal bill is considered that includes incentives for patient-centered medical homes and removing penalties for Medicare quality reporting programs.


Along with the SGR, leaders of the American Academy of Family Physicians (AAFP) is concerned that the program that pays primary care physicians increased rates for providing care to Medicaid patients has not been renewed. Without the program, physicians could see 40% cuts in Medicaid reimbursements.

“This cut in Medicaid payment may result in having less access to physicians in their offices and push patients to be seen in the more costly emergency room, actually increasing the total cost of care,” Robert Wergin, MD, president of the AAFP said in a press release. “No medical practice can sustain such steep drops in payment and keep their doors open to serve patients.” 

Robert S. Juhasz, DO, president of the American Osteopathic Association, says that new members of Congress will have to be educated and convinced of the importance of these physician payment issues.

“When the114th Congress convenes, this policy will very likely be re-examined and re-shaped due to the new members, committee assignments and priorities, causing a significant setback,” Juhasz said in a press release.