Doctor Payment Reform Finally Passes, Ends Decade-Long Stalemate


On April 14th, the Senate voted (92 to 8) to permanently repeal Medicare's sustainable growth-rate formula for physician payment. This decision prevented a 21.2% cut in payments to physicians, the day before the CMS was set to process claims at a reduced rate.

The sustainable growth rate package (approximately $200 billion) will implement a new two-track payment system for physicians that is designed to move their patients into risk-based payment models. Doctors who qualify for the alternative payment track will receive higher reimbursement rates beginning in 2019. It also extends the Children's Health Insurance Program by 2 years and provides $7.2 billion in funding for community health centers. The legislation also includes policy and financing provisions, such as a 6-month delay in the CMS' "two midnights" payment policy for short hospital stays.

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