Medicare physician payment updates and the sustainable growth rate (SGR) system

Medicare: Elements and Economics

Volumn , Issue , 2012, Pages 179-188

  Hahn, Jim ^a   Mulvey, Janemarie ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84892978645     PISSN: None     EISSN: None     Source Type: Book    
DOI: None     Document Type: Chapter

References (43)

1. For detail on fee-for-service Medicare and other Medicare background information, see CRS Report R40425, Medicare Primer, Medicare Primer, coordinated by Patricia A. Davis and Paulette C. Morgan.
2. Social Security Act, §1848. [42 U.S.C. 1395w-4]. In some instances, special rules apply to the calculation of Medicare fees for some services, including anesthesia, radiology, and nuclear medicine.
3. The Balanced Budget Refinement Act of 1999 (BBRA 99, P.L. 106-113) incorporated an adjustment for the prior year into the update adjustment factor (UAF) update calculation; it also moved from a fiscal year to a calendar year system.
4. The calculation of the 2012 MEI is provided in the final 2012 Medicare physician payment rule issued by CMS; see http://www.ofr.gov/OFRUpload/OFRData/2011-28597_PI.pdf.
5. See CMS Final Rule, Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010, Federal Register Notice, November 25, 2009.
6. Congressional Budget Office, Medicare's Payments to Physicians: The Budgetary Impact of Alternative Policies, June, 16, 2011; http://www.cbo.gov/ftpdocs/122xx/doc12240/SGR_Menu_2011.pdf.
7. See Table 6, Actual Past Medicare Economic Index Increases and Physician Updates for 1992-2009, and Estimated Values for 2010, in CMS publication, "Estimated Sustainable Growth Rate and Conversion Factor, for Medicare Payments to Physicians in 2010."
8. Centers for Medicare & Medicaid Services, Press Release, CMS Announces Policy, Payment Rate Changes for the Physician Fee Schedule in 2012, November 1, 2011. Also see Federal Register, vol. 76, no. 228, Medicare Program: Payment Policies Under the Physician Fee Schedule, November 28, 2011.
9. MedPAC, Letter to Congress, Moving Forward from the Sustainable Growth Rate (SGR) System, October 14, 2011.
10. U.S. Government Accountability Office (GAO), Medicare Physician Payments: Trends in Utilization, Spending and Fees Prompt Consideration of Alternative Payment Approaches, testimony of Bruce Steinwald before House Energy and Commerce Committee, July 25, 2006.
11. Often referred to as the tragedy of the commons: while it may be individually rational for each herder to let livestock graze on the common field (to preserve his own), the collective consequence of many such individual decisions is that the common fields are overgrazed and all herders suffer from the degradation or depletion of the common good.
12. MedPAC, Report to Congress: Medicare Payment Policy, Washington, DC, 2011.
13. 2009 Ambulatory Medical Care Survey.
14. For details on Medicare Part B premiums see CRS Report R40082, Medicare: Part B Premiums, by Jim Hahn.
15. P.L. 108-173, §953(a).
16. U.S. Government Accountability Office, Medicare Physician Payments: Concerns about Spending Target System Prompt Interest in Considering Reforms, GAO-05-85, October 8, 2004.
17. MedPAC, 2011 Report To Congress: Medicare Payment Policy.
18. P.L. 109-171, §5104(c).
19. MedPAC, Assessing Alternatives to the Sustainable Growth Rate System, March 2007.
20. MedPAC, Report to the Congress, Medicare Payment Policy, March 2008.
21. http://www.medpac.gov/transcripts/SGR%20sept%202011%20handout.pdf.
22. See §5501 of the Patient Protection and Affordable Care Act (P.L. 111-148).
23. MedPAC, Assessing Alternatives to the Sustainable Growth Rate System, March 2007.
24. The detailed list is available at http://www.medpac.gov/documents/10142011_MedPAC_SGR_letter.pdf.
25. Congressional Budget Office, Medicare's Payments to Physicians: The Budgetary Impact of Alternative Policies Relative to CBO's March 2012 Baseline. July 2012. http://cbo.gov/sites/default/files/cbofiles/attachments/43502-SGR%20Options2012.pdf.
26. See the transcript of the September 15, 2011, meeting, available at http://www.medpac.gov/transcripts/09150916MedPAC.pdf.
27. See CRS Report R41157, The Statutory Pay-As-You-Go Act of 2010: Summary and Legislative History, by Bill Heniff Jr.
28. See CRS Report CRS Report R41474, Accountable Care Organizations and the Medicare Shared Savings Program.
29. The following information is derived from CRS Report R41196, Medicare Provisions in the Patient Protection and Affordable Care Act (PPACA): Summary and Timeline, coordinated by Patricia A. Davis.
30. For details, see http://cbo.gov/ftpdocs/127xx/doc12764/hr3630.pdf.
31. For roll call details, see http://clerk.house.gov/cgi-bin/vote.asp?year=2009&rollnumber=985.
32. §188 of MIPPA established the Medicare Improvement Fund (MIF), available to the Secretary to make improvements under the original fee-for-service program under Parts A and B for Medicare beneficiaries.
33. For roll call details, see http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=1&vote=00384.
34. P.L. 111-118.
35. http://www.cbo.gov/budget/factsheets/2010b/SGR-menu.pdf.
36. CBO score available at http://www.cq.com/displayfile.do?docid=3299370.
37. See the Congressional Record at http://thomas.loc.gov/cgi-bin/query/B?r111:@FIELD(FLD003+s)+@FIELD(DDATE+20100225.
38. http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=2&vote=00032.
39. The vote was 417-1, with 14 Members not voting. See http://clerk.house.gov/evs/2010/roll393.xml.
40. See Congressional Budget Office, Estimate of the Statutory Pay-As-You-Go Effects for the Physician Payment and Therapy Relief Act of 2010, November 18, 2010, http://cbo.gov/ftpdocs/119xx/doc11969/PhysicianPaymentandTherapyReliefAct.pdf.
41. The Secretary is required (§1848(d)(1)(E) of the Social Security Act) to make public an estimate of the sustainable growth rate (SGR) and the conversion factor applicable to Medicare payments for physicians' services for the following year by March 1 of each year.
42. Centers for Medicare & Medicaid Services, Press Release, CMS Announces Policy, Payment Rate Changes for the Physician Fee Schedule in 2012, November 1, 2011.
43. MedPAC, Report to the Congress: Medicare Payment Policy, Washington, DC, March 2011, http://www.medpac.gov/documents/mar11_entirereport.pdf.