Freeze nursing home doctor pay for 10 years, replace Sustainable Growth Rate system, Senate Finance Committee told

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Senate Finance Committee Chairman Max Baucus (D-MT)
Senate Finance Committee Chairman Max Baucus (D-MT)

Medicare rates for physician visits to nursing homes should be frozen for 10 years as the government replaces the Sustainable Growth Rate system, a Medicare Payment Advisory Commission official advised the Senate Finance Committee.

Congress has intervened 15 times since 2003 to avoid the payment cuts called for by the current SGR system, prompting repeated calls for a permanent “doc fix.” The Senate Finance Committee convened a hearing on the topic Tuesday, marking the first hearing on SGR replacement since 2006.

In testimony to the committee, MedPAC Executive Director Mark Miller renewed recommendations that MedPAC offered Congress in 2011. Under this plan, the SGR would be replaced with legislated updates changing Medicare fees over 10 years. However, primary care payment rates would be frozen at current levels. Primary care includes visits to patients in nursing homes.

Due to revised numbers from the Congressional Budget Office, MedPAC estimates that reductions for non-primary care services could be 3% or less, Miller said. This is down from 5.9% in the organization's 2011 plan. However, this new estimate assumes that physicians would bear one-third of the cost of repeal, and the remaining two-thirds would be offset by other Medicare providers.

Long-term care providers have already taken hits from SGR fixes, such as reduced reimbursements on bad debt. American Health Care Association President and CEO Mark Parkinson alluded to these offsets prior to Tuesday's hearing, saying, “Tapping one group of providers to assist another doesn't strengthen the system.”

Parkinson also called for Congress to address the therapy cap exceptions process in any SGR fix.

The leaders of the Senate Finance Committee recently invited provider input on this issue. 

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