Overworked from budget passage, Senate recesses before SGR repeal vote

The Senate is going to wait more than two weeks before its takes action on a bill to repeal the Medicare sustainable growth rate (SGR) and avoid an imminent 21 percent cut in Medicare payments to physicians. Despite the fact that the physician pay cuts are scheduled to take place on April 1, 2015, Senate Republican and Democratic leaders announced that they would not take up the SGR issue until April 13, 2015. There was some advance warning for Medicare physicians. On March 24, 2015, CMS emailed physicians to warn them that the agency was preparing to implement the payment reduction as of April 1, 2015. At that time, CMS informed doctors that it would update them again on April 11, 2015 (see Countdown to April 1: CMS, docs prepare for cut in case SGR isn’t fixed, Health Law Daily, March 25, 2015).

H.R. 2

On March 26, 2015, the House passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015. If enacted, the bill would make changes to the Medicare physician payment system, notably through the SGR repeal, but would also extend several other expiring Medicare provisions. Additionally, the bill would make permanent certain Medicaid benefits, including the benefits for “qualified individuals” and the transitional medical assistance program (see House passes SGR repeal, March 26, 2015)


Following the House passage and President Obama’s endorsement of the bill, all that remains for final approval is a Senate vote. However, on Friday, the Senate took up a long session that led to the passage of the Senate budget resolution (see House passes budget, Senate to vote, and ACA remains in the crosshairs, Health Law Daily, March 26, 2015). Now, the Medicare payment issue will have to endure a two-week lapse, while Senators take a recess, before it goes under further consideration. Despite the time lag, Senate Majority Leader Mitch McConnell (R-Ky) indicated that the delay would not result in lower payments to Medicare physicians, explaining that the lag time that is inherent in Medicare payment processing means that the payment fix can be done a little late.


The Senate has received some backlash as a result of its decision not to move ahead with the SGR repeal immediately. Congressman Kevin Brady, (R-Texas) had strong words for the decision, saying “The Senate shouldn’t have left town without acting. I embrace the assurances they’ll act next month, but it’s hard to find an adequate reason for leaving our local Medicare seniors and doctors in yet another lurch, or delaying the first real reforms to save Medicare for the long term.” Additionally, the American College of Physicians (ACP) expressed disappointment that the Senate took a recess before passing the legislation and said that “doctors and patients must hold the Senate accountable for not passing SGR repeal.”

The Affordable Care Act at age five: a look back and a look ahead

Somewhere near their first birthdays, children learn to walk. At three years of age, they might start pedaling a tricycle, and at age five, they are poised to enter kindergarten. March 23, 2015, marks the fifth anniversary of the enactment of President Obama’s signature health reform law, the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Has the ACA, at five years of age, made the same amount of progress as a child?

Critics argue that the ACA has failed, but proponents say that it is moving closer to achieving its goal of quality, affordable health care for all Americans. As a law that seeks to expand health insurance coverage for Americans, improve the functioning of health insurance markets, and control the efficiency and quality of health care, the ACA has “had a major positive impact, and one that will continue to bring efficiencies over time,” said Keith Fontenot, the managing director of government relations and public policy at Hooper, Lundy & Bookman, P.C.

Regardless of whether it has met its milestones, it is clear that the ACA has already made an impact. It has had significant effects on the uninsured rate, the affordability of coverage via the provision of subsidies, the use of preventive services, and the actions of large employers and insurers. Many ACA provisions have gone into effect over the last five years; however, due to design or delay, a number of significant reforms have yet to be implemented or fully realized.

This White Paper looks at the ACA’s impact on Medicare and Medicaid issues and its impact on the private insurance market. It also looks at major ACA changes facing health care providers and employers in the coming months.

Read further, “The Affordable Care Act at age five: a look back and a look ahead.”

Meaningful use overhaul loudly requested at Senate hearing as penalties loom

A Senate hearing revealed concerns about the Electronic Health Records (EHR) Incentive Program that was implemented to encourage providers to adopt updated health information technology (IT). The hearing, convened by the Senate Committee on Health, Education, Labor, and Pensions (HELP) and entitled America’s Health IT Transformation: Translating the Promise of Electronic Health Records into Better Care, brought together a wide array of professionals invested in the effort to revamp the system of health care records.


The Health Information Technology for Economic and Clinical Health Act (P.L.111-5) allowed HHS to spend billions to promote the adoption of health IT. It also established meaningful use of EHR adoption to ensure that the implementation resulted in improvements in care. Senator Patty Murray (D-Wash) remarked that the HITECH Act played a large role in the significant jump in physicians who use EHR, from 18 percent in 2001 to 78 percent today.


Others testifying did not have many positive things to say about the effectiveness of meaningful use. Committee Chairman Senator Lamar Alexander (R-Tenn) is very concerned that almost 70 percent of physicians said “EHR systems have not been worth it.” Following the HITECH Act, providers rushed to adopt EHRs and join the meaningful use program. Half of these physicians have not met the requirements of the incentive program and are facing penalties. Although the deadline for compliance has been extended multiple times, many will not be ready when time is up, on March 20, 2015 (see Meaningful use deadline extended as HHS pledges to listen to physician input, Health Law Daily, February 25, 2015). Those who don’t adopt EHR systems will lose 1 percent of Medicare payments this year, and the penalty will grow. Providers have had to invest a significant amount of money in systems that were guaranteed to meet meaningful use requirements, but then needed costly upgrades or an entire overhaul of their IT system.

Dr. Robert L. Wergin, who owns a small rural practice and is the president of the American Academy of Family Physicians (AAFP), felt that overall, physicians are excited about future developments in health IT. However, he noted several struggles during his own transition to EHRs. He struggled to meet the criteria and experienced a loss of patient volume that still has not recovered to pre-EHR levels. Additionally, he finds that doctor-patient relationships have been negatively impacted by the struggle to meet regulations, and that the payment structure is inadequate.


Dr. Wergin and Senator Sheldon Whitehouse (D-RI) agree that meaningful use needs to see several changes. These include delaying penalties, overhauling documentation requirements, and including behavioral health and nursing homes. The past president of the American Health Information Management Association (AHIMA), Angela Kennedy, called for more oversight of information governance to ensure that data is both secure and correct. She has endured these struggles firsthand, due to her daughter’s misdiagnosis stemming from copy and paste errors in medical records. Senator Murray tried to remain positive about the future of the program and unite those involved “to do more to both set high standards, and ensure providers have the support and flexibility they need to reach them.”

Senators want to extend and expand Medicaid payment rate increase

A new Senate bill would extend reimbursement parity for doctors who treat Medicare and Medicaid patients, and would also apply to nurse practitioners and physician assistants who treat women and children. The Ensuring Access to Primary Care for Women & Children Act (S.B. 737) is sponsored by Senator Sherrod Brown (D-Ohio) and Senator Patty Murray (D-Wash). The original provision was part of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), but was allowed to expire on December 31, 2014.

Medicaid provider shortage

In 2012, a report indicated that more than a third of physicians refused to take Medicaid patients because of the low reimbursement rates. Provider fees were temporarily hiked to match the reimbursements received for treating patients enrolled in Medicare. The expiration of the provision resulted in a substantial pay cut for primary care providers who were treating Medicaid patients. The bill’s sponsors are concerned that Medicaid enrollees, especially women and children, will be unable to find care in a timely manner if more providers refuse to see them. Following the expansion of Medicaid in many states under the ACA, almost 70 million Americans were enrolled as of December 2014.


The president requested a one-year extension in the 2014 budget proposal, but nothing has come from it. The senators feel that offering higher rates to providers will cut down emergency room visits for needs that could be easily addressed by primary care providers, which has been a serious problem for Medicaid programs. Research supports the idea that higher reimbursement rates increase appointment availability for enrollees. This extension does not come cheap, as CMS estimates come in as high as $11 billion for Medicaid.


This bill would go farther than the original ACA provisions, as ob-gyns, plus nurse practitioners and physician assistants who treat women and children, would also be included. This would impact a significant portion of Medicaid enrollees. In 2009, the majority of adult women enrolled in the program were considered of reproductive age. Women are more likely to regularly see an ob-gyn than any other type of doctor. Additionally, more people are seeking care from nurse practitioners and physician assistants as primary care providers become increasingly overloaded.