PA Hospice and Other Provisions Included in SGR Reform Proposals

With a nearly 24 percent Medicare payment cut scheduled to take place Jan. 1, Congress is poised to override the spending target determined by Medicare’s sustainable growth rate (SGR) formula and apply a 0.5 percent increase for payments to healthcare professionals through April 1, 2014. The three-month SGR patch was passed by the U.S. House of Representatives on Dec. 12 as part of the budget agreement for federal discretionary spending levels for fiscal years 2014 and 2015. The U.S. Senate is expected to take up the budget agreement, along with the SGR patch, this week.
Meanwhile, both the House and Senate continue to move forward with bipartisan legislation to repeal the SGR and reform Medicare’s payment system. The House Committee on Energy and Commerce was the first committee to pass legislation to repeal and replace the SGR in July. On Dec. 12, the House Committee on Ways and Means and the Senate Finance Committee followed suit. All three bills repeal the SGR, replacing it with a payment system that moves away from fee-for-service and moves toward a new value-based performance (VBP) program and provides incentives to develop alternative payment models (APM), such as medical homes, accountable care organizations and bundled payments.
Payment for fee-for-service would be frozen for 10 years with an increase of 1 percent in 2024. The VBP program would take into account quality, resource use, and clinical practice improvements and apply to payments for items and services furnished after Jan. 1, 2017. The APM incentives would begin in 2016.
PAs are treated in the same way as physicians and advanced practice nurses in the fee-for-service, VBP and APM programs. Additionally, PAs, physicians and advance practice nurses are eligible to provide chronic care management through the SGR reform bills. The Ways and Means Committee passed an SGR bill by a 39-0 vote, but it did not allow any amendments to the bill. The Senate Finance Committee included several scheduled amendments into the “chairman’s mark,” the legislation to be considered by the committee.
Among those amendments included in the mark, and subsequently passed by the committee, were:
An amendment sponsored by Sens. Mike Enzi (R-WY) and Tom Carper (D-DE) to amend Medicare to allow PAs to provide and manage hospice care for Medicare beneficiaries
An amendment offered by Sens. John Thune (R-SD), Michael Bennet (D-CO), Mike Enzi (R-WY) and Pat Roberts (R-KS) clarifying that general supervision by a physician or nonphysician practitioner is allowed at critical access hospitals (CAHs) for payment of therapeutic hospital outpatient services, and that nonphysician practitioners (PAs and advance practice nurses) may directly supervise cardiac and pulmonary rehabilitation services
SGR reform has come a long way, but hurdles remain. None of the committees that passed SGR legislation, for example, have included the cost offsets or “pay-fors” for enacting the reform. Once Congress returns in January, each body of Congress must determine the “pay-fors,” which will be considered on the House and Senate floors when each SGR package is debated and voted upon. After the House and Senate have passed SGR legislation, differences must be reconciled through a House-Senate conference committee.
AAPA has engaged the relevant congressional committees throughout the development of SGR proposals. Our overarching message has been straightforward: Treat PAs in the same manner as physicians and NPs, whether it relates to new benefits or new quality measures, and modernize Medicare to reduce unnecessary barriers to the quality medical care provided by PAs.
To date, all SGR proposals have embraced AAPA’s overarching message, and the Senate Finance Committee has addressed two federal barriers to care provided by PAs.
AAPA will continue to advocate for PAs in SGR repeal and reform, including retaining the PA hospice and critical access hospital provisions in the final legislation. Expect to hear from AAPA in the coming months as we ask you to add your voice to the continuation of this important public debate on Medicare payment reform.