The SGR Has Been Repealed. Now What?

With the long awaited and historic repeal of the sustainable growth rate (SGR) formula two weeks ago, national health policy analysts and North Carolina Medical Society (NCMS) staff have been digging through the legislation to uncover what it all means for you and your practice going forward.

First, add a new acronym to your vocabulary – MACRA, which stands for Medicare Access and CHIP Reauthorization Act, which is the legislation that repealed the SGR.

See a year-by-year summary of MACRA’s new payment structures through 2026 and beyond here.

Most immediately, some practices may have had claims processed at the decreased rate before the bill was signed into law. Palmetto GBA, the Medicare administrator for North Carolina, offers answers to the questions they’ve received about this here.

MACRA contains many provisions beyond repeal of the SGR, perhaps most significantly that Physician compensation will be adjusted based on performance under the new law’s Merit-Based Payment Incentive System (MIPS). This includes incentive/penalty programs like the Physician Quality Reporting System (PQRS), EHR/Meaningful Use Incentive Program, and Value-Based Payment Modifier (VBPM). Professionals who treat few Medicare patients, or those who receive a significant share of their revenue from eligible Alternative Payment Models (APMs) will be excluded from the MIPS.

Get a better understanding of these various programs and the deadlines that apply at the Quality Time with the NCMS webpage (you must register on the NCMS website in order to access the information on this page).

Other provisions include:

  • Electronic Health Records (EHR) must be interoperable by 2018 and prohibits providers from deliberately blocking information sharing with other EHR vendor products. MACRA defines “Interoperability” as “the ability of two or more health information systems or components to exchange clinical and other information…to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improved patient outcomes.”
  • Extension of funding for Community Health Centers (CHC) and National Health Service Corps Fund (NHSC) and Teaching Health Centers. The fund for all three programs was set to expire in September 2015, but MACRA authorizes an additional two years of funding through fiscal year 2017.
  • No delay in implementation of ICD-10.

Watch the NCMS Bulletin and website for ongoing updates on what the new law means for you.

 
 

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