Medicare Physician Payment Reform

Unless Congress acts, the Sustainable Growth Rate (SGR) formula will continue to trigger massive cuts to physician reimbursement, slashing payments despite Medicare rates that are already well below market rates. These threatened cuts, paired with other potential cuts from the Independent Payment Advisory Board (IPAB) and the Budget Control Act (sequestration), imperil the viability of many physicians’ practices and limit patient access to specialty care.

ASCRS urges Congress to act immediately to replace the flawed SGR formula, with a system that updates reimbursements on the actual cost of providing care; ensures adequate reimbursement for all physicians to avert shortages among specialists and primary care; maintains a fee-for-service option; and provides an appropriate timetable and required investment for reforms.

We urge Congress to support the “Medicare Patient Empowerment Act” (S. 236 in the 113th Congress), which would establish a Medicare payment option for patients and physicians to contract without penalty for services covered by Medicare, while allowing patients to use their Medicare benefits and allowing physicians to bill the patient for all amounts not covered by Medicare.

ASCRS’ Three Main Legislative Priorities to Reform Medicare Physician Payment: