The U.S. House Thursday voted overwhelmingly in favor of scrapping Medicare's sustainable growth-rate formula, passing a permanent doc fix 392-37. The measure next goes to the Senate for a vote. President Barack Obama has indicated he will sign the measure.
The Senate still needs to pass the bill before adjourning on Friday. Senate Democrats have raised concerns about abortion language in the legislation and only extending the Children's Health Insurance Program for two years, but those reservations have faded as the repeal package has gained momentum. If enacted it would end a cycle of short-term doc fixes that has persisted for more than a decade.
The legislation gives physicians an annual 0.5% bump for the next four years. Payment rates would then hold flat for six years. Then most doctors would see annual 0.25% payment increases.
The bill also sets up a two-tier payment system that provides incentives for doctors to shift more of their practice into value-based payment models, including accountable care organizations, bundled-payment arrangements and medical homes.
House Minority Leader Nancy Pelosi called the bill “transformative in how it rewards the value not the volume” Thursday morning while speaking to the House.
House Speaker John Boehner, speaking on the House floor prior to the vote, said Congress' history of passing temporary patches for SGR are over and “in its place, we'll deliver for the American people the first real entitlement reform in nearly two decades.”
The bill resulted from a deal crafted by Pelosi and Boehner to come up with a compromise permanent fix that both parties could support. Each side made concessions, such as only a two-year extension for the Children's Health Insurance Program. Democrats had wanted a four-year extension.
Addressing that issue in her remarks on the floor, Pelosi said the failure to get a four-year extension “does not diminish the important of the two years extension.”
Both Democratic and Republican congressmen rose to speak in favor of the measure during the floor debate that preceded passage.
“Republicans and Democrats are finally fixing Medicare's broken payment system. For way too long, a so-called SGR has been an ax over Medicare positions and the seniors they care for," said Rep. Fred Upton (R-Mich.)
“Well, this is indeed a rare event. It was an event really waiting to happen," said Rep. Sandy Levin (D-Mich.), referring to both parties agreeing on a bill in the current highly partisan atmosphere that has produced congressional gridlock on other key issues.
Rep. Renee Ellmers (R-N.C.,) agreed. “Don't look now, but we are actually governing.”
Major healthcare associations reacted positively to House passage of the measure and urged quick Senate action as well.
“The House of Representatives has voted to remove the dark cloud of financial uncertainty over physician group practices," said Dr. Halee Fischer-Wright, president and chief executive officer of the Medical Group Management Association, in a statement. "Medicare innovation has been hampered far too long by the SGR. The Senate is one vote away from returning stability to patients and physicians in Medicare. MGMA urges the Senate to immediately vote to repeal the SGR."
Dr. Robert M. Wah, president of the American Medical Association, said, “We urge the U.S. Senate to take swift action to approve the policy and send it to the President's desk before the current SGR payment patch expires on March 31."
The bill “supports innovative new delivery and payment models that will help improve care quality, health outcomes and lower costs. It also assures access to care for children, low-income individuals and families by extending funds for the Children's Health Insurance Program and community health centers.” Wah said is a statement.