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ARTICLE · 29 OCTOBER 2013

SGR Reform—Improved Outlook For Congressional Action This Year?

Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
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The Sustainable Growth Rate (SGR) formula was enacted in 1992 as a statutory means of controlling Medicare spending by calculating annual updates to the Medicare physician fee schedule.

United StatesStrategy
  • A bicameral impetus to reform the SGR, and a coalescence around legislative principles, has been a rare bipartisan development in an otherwise divided Congress this year.
  • The primary potential sticking point for achieving SGR reform is how to "offset" or pay for the overhaul, which has up to a $175 billion price tag, amidst the political context of budget negotiations and implementation of the Affordable Care Act.
  • A major overhaul of the SGR will have significant operational and reimbursement implications for health care providers.
  • With just over two months remaining in the legislative calendar, there is precedent for large legislative items to move following a government shutdown.

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