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House Bill Would Repeal SGR, Raise Physician Pay

United States Reps. Allyson Schwartz (D-PA) and Joe Heck, D.O. (R-NV) introduced the Medicare Physician Payment Innovation Act Wednesday to ensure patient access to physicians while promoting efficiency, quality and value in health care delivery. The bipartisan legislation permanently repeals the flawed Sustainable Growth Rate (SGR) formula and sets out a clear path toward comprehensive reforms of Medicare payment and delivery systems. This week, the Congressional Budget Office significantly lowered its estimate of the cost to permanently repeal the SGR from $245 billion to $138 billion.

Allyson Schwartz

“For over a decade, this policy has failed taxpayers, Medicare beneficiaries and those on the frontlines of patient care. The framework for this legislation has garnered broad bipartisan support over the past year,” said U.S. Rep. Schwartz (PA-13). “I look forward to working with Representative Heck and my Republican and Democratic colleagues on the Ways & Means Committee to pass legislation this year that fully repeals the SGR and moves us toward our shared goals of rewarding quality, providing better integration and coordination of care, and ensuring seniors get the care they need when they need it. There is no excuse for further inaction.”

The Medicare Physician Payment Innovation Act puts in place vital delivery system and payment reforms to ensure long-term stability in the Medicare physician payment system and contains the rising growth in health care costs.

Joe Heck, D.O.

“This bipartisan legislation puts an end to the annual question of whether physicians can continue to accept Medicare patients,” said Jeffrey Cain, MD, president of the American Academy of Family Physicians during a news conference outlining the bill. “It stabilizes the Medicare system. And it promotes solutions that are based on successful delivery models.”

Jeremy Lazarus, M.D., President of the American Medical Association, said “Reps. Schwartz and Heck clearly understand that this decade-long cycle of scheduled cuts and short-term patches must end so we can protect access to care for Medicare patients, reward quality and reduce costs.”

Summary of the Medicare Physician Payment Innovation Act:

  • Permanently repeals the SGR formula
  • Provides annual positive payment updates for all physicians for four years
  • Ensures access to preventive care, care coordination, and primary care services through increased payment updates for those services
  • Aggressively tests and evaluates new payment and delivery models
  • Identifies a variety of unique payment models to provide options for providers across medical specialties, practice types, and geographic regions
  • Stabilizes payment rates for providers who demonstrate a commitment to quality and efficiency within a fee-for-service model
  • Ensures long-term stability in the Medicare physician payment system through predictable updates that accurately reflect the cost and value of providing health care services in coordinated care models

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