Physician SGR Formula

News & Analysis as of

Washington Healthcare Update

This Week: Senate Reauthorizes Older Americans Act; Bill Heads to the House... White House Holds 2015 Conference on Aging and Launches Several New Administration Healthy Aging Initiatives Enveloping Alzheimer’s, Dementia,...more

Washington Healthcare Update

This Week: 21st Century Cures Legislation Passes House in Bipartisan Vote... CMS Releases Proposed CY 2016 Home Health Prospective Pay Rule... CMS Releases Final CY 2016 Hospital Outpatient Prospective Payment System (OPPS)...more

SGR Fix Bill Includes Important Change to Gainsharing CMP

President Obama recently signed into law Public Law No. 114-10, the “Medicare Access and CHIP Reauthorization Act of 2015” (P.L. 114-10), which overhauls Medicare physician reimbursements by eliminating the use of the...more

MIPS: Moving Physician Payments Beyond the Sustainable Growth Rate?

Medicare continues to transition its primary physician payment methodology from a traditional fee-for-service model into a quality and value-based model. Recently, the Medicare Access and CHIP Reauthorization Act of 2015...more

Medicare Part B Reimbursement After the SGR Repeal

On April 16, 2015, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 and thereby repealed the sustainable growth rate (“SGR”) Medicare Part B provider reimbursement methodology,...more

SGR Law Creates Merit-based Incentive Payment System and Incentives for Alternative Payment Model Participation

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA” or the “Act”), signed into law by President Barrack Obama on April 16, has been touted as one of the most significant Medicare payment reforms in decades, with...more

Physicians Finally Get Permanent Medicare Payment Solution

On April 16, 2015, President Obama signed into law a permanent sustainable growth rate (“SGR”) fix. The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) eliminates the Medicare SGR methodology, which has been...more

Also In The News - Health Headlines - April 2015 #4

CMS Announces Round 1 2017 DMEPOS Competitive Bidding System – On April 21, 2015, CMS announced plans for a new bidding process for the supplier contracts awarded in the Round 1 Recompete of the DMEPOS Competitive Bidding...more

MACRA, the Sustainable Growth Rate (SGR) Reform Bill, Signed into Law - CMS Quality Reporting Programs and Value-Based Payments...

The Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act, or MACRA, was signed into law on April 16, 2015. The law replaces the sustainable growth rate (SGR) formula with statutorily prescribed...more

“Doc Fix” Bill Mandates Anti-Fraud Enforcement Tools

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015, better known as the “doc fix” bill, as an attempt to fix the flawed Medicare reimbursement system implemented by the...more

SGR Legislation Includes Gainsharing Fix and More Anti-Fraud Measures

The legislation repealing the Medicare sustainable growth rate formula (SGR), signed by President Obama on April 16, 2015, contained several anti-fraud related provisions that affect the health care industry. The provision...more

Five Things to Know About the Medicare SGR Fix

H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), was signed into law by President Obama on April 16, 2015. A broad bipartisan compromise measure, MACRA repeals the much-maligned sustainable growth rate (SGR)...more

President Signs Into Law Changes to Medicare Physician Reimbursement Formula

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 ("the Act"). The national headlines about the Act’s passage focused on the repeal of the sustainable growth rate...more

MACRA: Program Integrity and Fraud and Abuse Provisions

On Thursday April 16th, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Pub.L. 114-10. In two previous posts, we discussed MACRA’s repeal of the Sustainable Growth Rate...more

President Obama Signs SGR Repeal Legislation; New Physician Payment Methodology Begins in 2019

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals the Medicare Sustainable Growth Rate (SGR) that was set to cut Medicare Physician Fee...more

Passage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): The “Doc Fix”

The President has signed into law the bipartisan bill H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently repeals the flawed Sustained Growth Rate (SGR) formula and replaces it with a stable...more

The SGR Fix: Congress Charts a New Course for Physician Payments and Gainsharing

On April 16, President Obama signed into law the “Medicare Access and CHIP Reauthorization Act of 2015,” (“MACRA”) which repealed the Sustainable Growth Rate (“SGR”) payment formula used to limit annual updates to Medicare...more

Permanent “Doc Fix” Legislation Substitutes Merit-Based Incentive Payment System for SGR, and Contains Other Reimbursement and...

In addition to finally repealing the so-called sustainable growth rate methodology (“SGR”) for adjusting Medicare physician payments that Congress has overridden consistently since 2004, the newly enacted Medicare Access and...more

Reed Smith's Government Contracts Weekly Rundown - April 2015 #3

Here is a rundown of last week’s top developments related to government contracts to get you back on track and ready for this week....more

Health Care Update - April 2015 #2

In This Issue: - With SGR Behind Us, Delivery Reform Up Next - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional Initiatives - Other Health...more

Beyond SGR – MACRA Provides Additional Payment Provisions and Offsets

This is the second post in our continuing series on the Medicare Access and CHIP Reauthorization Act (MACRA). Pub.L. No: 114-10. In addition to repealing the Sustainable Growth Rate (SGR), which was covered in our April 20th...more

Manatt on Health Reform: Weekly Highlights - April 2015 #3

This week, CMS proposes continued 90% funding for Medicaid eligibility and enrollment system development. Montana is on the verge of becoming the 29th state (plus D.C.) to expand Medicaid eligibility, and Florida Governor...more

“Doc Fix” Signed into Law; 21% Physician Pay Cut Avoided

President Obama has signed the “doc fix” into law, which permanently avoids a 21% pay cut for physicians that was slated to take effect this April. The law received broad bipartisan support, passing in the House of...more

Congress Repeals Sustainable Growth Rate Formula and Advances Medicare Payment for Quality

On April 14, 2015, Congress ended over a decade of repeated “doc fixes” which temporarily suspended scheduled Medicare provider reimbursement cuts, by passing the Medicare Access and CHIP Reauthorization Act (the “Act”). If...more

Does the "Doc Fix" Bill Help Telemedicine and Telehealth?

In a word: yes. Telemedicine was one of the many beneficiaries of changes introduced by the so-called “doc fix” bill, formally titled the Medicare Access and CHIP Reauthorization Act (H.R. 2). The legislation was passed by...more

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