Paul Ryan Tells Hall Render Congress “Ready” to Reform SGR, but Questions Remain
On Monday, House Budget Committee Chairman and Ways and Means Committee member Paul Ryan (R-WI) told John Williams, the head of Hall Render’s federal advocacy practice area, that Congress is “ready” to permanently reform the Sustainable Growth Rate (“SGR”) formula. “We’re ready to do it. We’ve already got the plan written,” Ryan told Williams at a small gathering of former Capitol Hill aides who worked together in the 1990s. Yet, developments this week show the chances of Congress adopting a permanent replacement for the formula used to determine Medicare physician payment rates continue to grow smaller.
After announcing that it would no longer pursue a joint solution with the Ways and Means Committee, the Energy and Commerce Subcommittee on Health held a hearing on Wednesday to highlight its own plan for permanent SGR reform. That legislative proposal has been criticized for failing to identify alternative payment models to traditional fee-for-service or recommending how Congress should pay for the $139 billion needed to achieve permanent reform. At the hearing, lawmakers talked at length about the need to act this year but failed to add any new provisions that would advance their proposal.
Meanwhile, the Senate Finance Committee continues to work on its own legislation, and the Ways and Means Committee is expected to release the plan Chairman Ryan referenced in the coming weeks. However, any differences in these proposals will have to be reconciled, which will slow down the legislative process even further. In addition, policy experts expect the Congressional Budget Office to increase the cost of a permanent replacement when it releases its revised budget estimate in August. If the cost of a permanent replacement grows much higher than $139 billion, the chance of Congress passing permanent reform legislation will undoubtedly drop to zero.
CMS Releases Medicare Prices for Outpatient Treatment
On June 3, CMS released Medicare hospital data on the charges for 30 types of hospital outpatient procedures. The release builds on a move last month where CMS publicized the 100 most common inpatient procedures. The records show the average national costs for outpatient care, imaging and outpatient tests were $3,236 in 2011.
The release of the hospital data comes after the Time Magazine article this spring by Steven Brill that highlighted the perceived inconsistency of the hospital chargemaster.
CMS also released county-by-county data on Medicare use and spending and on Medicare use by those with chronic conditions.
Track and Trace Bill Passes House
On June 3, the House passed H.R. 1919, the Safeguarding America’s Pharmaceuticals Act of 2013. Passage of the bill was expected as it passed on a voice vote. The Senate HELP Committee has passed a version of the legislation (S. 959), but it’s not clear when that will go to the full chamber.
The House bill would require “lot level” tracing and calls on the FDA to propose a rule for a unit-level system in 2027 but does not require the agency to follow through and finalize the regulations.
Health Care-Related Bills Introduced This Week
H.R. 2286: Rep. Lucille Roybal-Allard (D-CA) introduced a bill to promote optimal maternity outcomes by making evidence-based maternity care a national priority. It was referred to the House Committees on Energy and Commerce and Ways and Means.
H.R. 2302: Rep. Tom Reed (R-NY) introduced a bill to strengthen and protect Medicare hospice programs. It was referred to the House Committees on Energy and Commerce and Ways and Means.
Next Week in Washington
The House Energy and Commerce Subcommittee on Health announced they will hold a hearing on Medicaid reform at the state level. The hearing will be held on June 12.
For more information, please contact John F. Williams, III at 317-977-1462 or jwilliams@hallrender.com.
