December 5, 2021

Volume XI, Number 339

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December 03, 2021

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December 02, 2021

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Sustainable Growth Rate (SGR)

Both the American Hospital Association and the American Medical Association (together with numerous physician specialty organizations), have submitted letters to the Medicare Payment Advisory Commission (MedPAC) in response to a “Proposal” which MedPAC adopted yesterday, on various issues.  MedPAC Proposal freezes payments for certain primary care services and reduces reimbursement for all other “specialist services,” whether provided by a primary care physician or specialist, by 5.9 percent for three consecutive years and is thereafter frozen.  That means physicians would be looking at approximately an 18 percent cut at the end of the three year period in their compensation for many procedures they provide.

In order to maintain the level of reimbursement for certain primary care providers and cut reimbursement for any other procedures by “only” 18 percent, the MedPAC is recommending other cuts to other healthcare providers.  Such cuts could end up adversely affecting the ability of other healthcare providers to provide the assets necessary for a physician to provide the appropriate care deemed necessary by that physician for patients.

A major concern is the fact that it is now ninety days before the implementation of the 30 percent cut under the Sustainable Growth Rate provision in existing law, which would become effective January 1, 2012 if Congress does not act, and that issue has not been resolved.

© 2021 Giordano, Halleran & Ciesla, P.C. All Rights Reserved National Law Review, Volume I, Number 290
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About this Author

Frank R. Ciesla, Giordano Law Firm Health Care Litigation Health Care Fraud and Abuse Tax Health & Hospital Law
Of Counsel

Mr. Ciesla is Chair Emeritus of the firm's Health Care Law Practice Area. His practice is primarily devoted to Health Care and Government Contracts Law. He counsels clients on legal developments facing healthcare providers in the modern health care environment. Firm clients include hospitals, nursing homes, physicians and physician groups, individual practice associations, home health agencies, ambulance carriers and industry-wide associations.

Mr. Ciesla advises such clients on business structures, mergers and consolidations, joint ventures, reorganization of health care providers...

732-741-3900
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