Thursday, November 14, 2013

AHCA Responds to Congressional SGR Reform Framework

By Drew Thies

The American Health Care Association (AHCA) released remarks Tuesday following a proposed framework put forth by Congress to reform the sustainable growth rate (SGR). The remarks focused primarily on preserving funding for Medicare Part B providers and creating a solution to the therapy cap problem.

AHCA is supportive of the framework’s general goal to reform the fee-for-service system and create a greater emphasis on quality over volume of care. However, given Congressional budgetary restrictions currently in place, AHCA contends that an undue burden should not be placed on its providers, given past cuts. The billions absorbed by skilled nursing in recent years must be taken into account when creating a budget-neutral fix.

Additionally, AHCA views the SGR discussion as a critical time to address the root of administrative backlogs created by the current therapy review process. Manual medical review (MMR) has resulted in massive delays in payment decisions for providers who extend therapy services to patients beyond arbitrary therapy caps dictated by the SGR. AHCA, along with a coalition of organizations with expertise in therapy, proposed a series of fixes to the MMR that will better ensure providers are well-informed and properly reimbursed for these critical services.

The Senate Finance and House Ways & Means committees released a framework for a permanent fix to the SGR on October 31, calling for comments from stakeholders on the proposed path forward. Enacted in 1997 to control the rate of Medicare reimbursement for physician services, the SGR system largely failed, and has resulted in an annual ritual known as the “doc fix.” The yearly manual reconfiguring by Congress leads to much uncertainty in reimbursement rates across the board.

As Congress continues to discuss changes to the SGR, you can join in too. Check out AHCA’s Advocacy Alert to see if one of your Members of Congress is on one of the key committees controlling this critical issue and get in touch today. Discussions are happening now, however, and there is precious little time left on legislative calendar, so do not hesitate to reach out.

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