This Week – December 14, 2013

This Week in Washington DC:

  1. House of Representatives passes legislation to temporarily avert Medicare cuts but extend sequestration cuts to Medicare providers by 2 years
  2. SGR reform bill gains momentum on Capitol Hill

House passes legislation to avert SGR cuts in 2014 but adds more cuts to Medicare providers in the out-years

On Thursday, the House of Representatives passed the Bipartisan Budget Act of 2013, by a vote of 332-94. As part of this package, the House also passed a 3 month Medicare reimbursement update of 0.5% instead of the looming 20+% Medicare reimbursement cut due to the sustainable growth rate (SGR) formula and other changes to the 2014 Medicare conversion factor.   

The agreement, crafted by Rep. Paul Ryan (R-Wis.) and Sen. Patty Murray (D-Wash.), sets discretionary spending at more than $1 trillion for the next two fiscal years and repeals sequester cuts in certain areas such as medical research and defense slated to take effect in January. However, the agreement extends across-the-board cuts (known as sequestration) in Medicare spending programs for an additional two years—2022 and 2023—beyond the period under current law. Those additional cuts would be the same percentage of spending required under current law (until 2021), which are annual 2% cuts. This means that Medicare providers (facilities and physicians) will receive an additional 2% cut each year for an additional 2 years than originally implemented under sequestration, or for the next 11 years. 

The Senate is expected to vote on the package next week before adjourning for the year.

The budget deal now buys more time for finishing work on SGR repeal bills moving through both the House and Senate. ACG will continue to update membership as the Senate addresses SGR cuts but also seeks to pass unwarranted cuts to Medicare providers by extending sequestration.

ACG members should also know that potential cuts to colonoscopy may be on the horizon. This is one reason why ACG continues to urge Congress to pass the SCREEN Act (S. 608 / H.R. 1320) despite the tough political environment on Capitol Hill. This bill improves quality of care in our specialty, lowers patient barriers to life-saving colorectal cancer screening, and also strives to ensure Medicare reimbursement for colonoscopy is fair. This is a very crucial time for clinical gastroenterology and our patients. Please urge your leaders to support the SCREEN Act:

Medicare reimbursement reform legislation clears another hurdle in Congress

Also on Thursday, the House Ways & Means Committee and Senate Finance Committee approved proposals that would permanently repeal the SGR formula. The committees held separate meetings to “mark-up” or make changes to the draft before voting to approve the proposals. The next steps include possibly combining these proposals with the House Energy & Commerce proposal released over the summer, then a final vote in each chamber in early 2014 and before the recently passed 3 month reprieve from SGR cuts ending in March 2014. 

The House Ways & Means Committee’s version gives providers a 0.5% increase for 3 years before providers participate in a value-based purchasing program or other alternative payment models beginning in 2017. The Senate Finance Committee’s proposal freezes Medicare providers’ reimbursement for these 3 years (0% update) and providers have the opportunity to achieve bonuses based on their participation in a similarly crafted value-based purchasing program or other alternative payment models beginning 2017. Each proposal would also make changes to Medicare reimbursement code reviews that are currently administered by the AMA RUC.

While ACG is encouraged about the prospects for SGR repeal, many obstacles remain ahead—including the major question of how to pay for it. No offsets were discussed in either mark-up. The Congressional Budget Office (CBO) found that simply repealing the SGR for 10 years would cost $116.5 billion. CBO found the Senate Finance Committee legislation would cost $148.6 billion over that 10 year time period. The cost of the Ways & Means measure approved Thursday is not yet known.

ACG also remains very concerned that these proposals lock in recently announced Medicare reimbursement cuts impacting GI clinicians in 2014 as well as in 2015. ACG will continue to fight these cuts and engage policy makers on your behalf throughout this process. 

Please stay tuned for further updates. Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, go to and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway