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CMS and the Economic S.G.R for 2008-15?

CMS to Docs … Payments to Drop!

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According to Modern Physician, November 1, 2007, Medicare payments to physicians in 2008 will drop nearly 10 percent under a final rule issued by CMS, which estimates it will pay approximately $58.9 billion to 900,000 physicians and other health care professionals next year. The sustainable growth rate formula, which is tied to the health of the economy and is used to calculate physician payments under the Medicare program, is the force driving the projected cut.


Since it has been estimated that payments will drop by more than 40 percent by 2015, unless the SGR is replaced, do you think Congress will adopted interim measures to stop payment reductions?



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7 Responses

  1. But a Modest Medicaid Pay Increase

    According to the Kaiser Family Foundation and Health Management Associates, thirty-three states plan to increase their Medicaid payment rates for doctors in 2008. Many also are ready to expand eligibility and to use the program to cover more of the uninsured. Enrollment dropped in 2007 for the first time in a decade, apparently due to the improved economy and new citizenship rules.

    A Health Accountant


  2. Increased Medical Practice Costs

    Two recent MGMA studies highlight the rising costs faced by US medical practices. One study shows that costs are increasing more rapidly than revenue for many practices; another indicates that participation in the Medicare quality reporting program burdens practices with additional costs and administrative hassles.

    And so, have you discerned this trend in your practice, clinic or medical facility; and what are you doing about it?

    Ann Miller RN MHA


  3. Stay cool all Doctors,

    Look; remember when cuts like this have been proposed before, Congress often rode in and stopped CMS from implementing such payment reductions.

    Now, the Senate Finance Committee that is considering a package which would suspend the reduction for two years, prevent reductions in rehabilitation therapy and increase reimbursement for rural providers.

    So, stayed abreast for even more changes, and opine?

    Ann Miller RN MHA


  4. Reprieve

    As predicted, physicians will get a six-month reprieve from a 10.1 percent across-the-board cut in Medicare payments that was scheduled to go into effect January 1, 2008.

    In fact, there wil be a slight increase! Go figure.

    Ann Miller RN MHA


  5. Doc-Fix Amendment in Repeal Resolution

    When the U.S. House of Representatives votes on whether to repeal the Patient Protection and Affordable Care Act next week, it will also vote on a resolution to replace the landmark 2010 law—which includes an amendment to permanently fix the Medicare physician payment formula. House Rules Committee Chairman David Dreier (R-CA) this week introduced a resolution that directs the House Ways and Means Committee as well as the Energy and Commerce, Education, Workforce, and Judiciary committees to begin the work of drafting replacement provisions to the Affordable Care Act.

    These provisions would foster economic growth and job creation; lower healthcare premiums through greater competition and choice; expand incentives to encourage personal responsibility for healthcare costs; and eliminate duplicative government programs and wasteful spending. Included in Dreier’s resolution was an amendment from Rep. Jim Matheson (D-UT) that instructs the committees to find a permanent fix to the sustainable growth-rate formula. That could mean good news for physicians, except for the fact that it’s attached to a bill that the AMA does not support.

    Source: Jessica Zigmond, ModernPhysician.com [1/7/11]


  6. CMS Private Health Insurance Premium Growth Projections

    According to recent projections by Centers for Medicare & Medicaid Services:

    • 2012-2013 spending for total private health insurance premiums projected to have grown by 3.3%.
    • 2013 premiums expected to grow at 3.0% due to 6.0% growth in net cost of private health insurance.
    • 2014 private health insurance premium growth is projected to reach 6.6%.
    • 2015 private health insurance spending growth expected to remain elevated at 6.9%.
    • 2016-2023 average private health insurance spending growth expected to sustain at 5.4% per year.

    Source: NHE Projections 2013-2023 – Forecast Summary
    CMS, September 2014


  7. UDATE 2015-2016 Doc fee Hike

    Physicians will see a 0.5% overall increase in Medicare reimbursement in 2016 under the proposed physician fee schedule announced Wednesday by the Centers for Medicare and Medicaid Services (CMS).

    There is also some “pain” in the CMS proposal: gastroenterologists are getting cut 5% and radiation oncologists face a 3% pay cut. But pathologists are the big winners with an 8% raise.


    The proposed fee schedule, which will be finalized this fall, is the first to be issued since Congress repealed the much-abhorred sustainable growth rate (SGR) payment formula in April.

    The 0.5% update was specified in the SGR repeal bill, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

    Ann Miller RN MHA


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