Congress considering Medicare physician restrictions

Legislation passed by the Senate Finance Committee and the House Ways and Means Committee would repeal the Medicare physician sustainable growth rate (SGR) formula but would also give the HHS Secretary unprecedented power to control the practice of medicine. Both the Senate and House bills would eliminate the SGR, a measure used by Medicare to calculate annual adjustments in payment rates to physicians. The goal of the formula is to control growth in Medicare's annual spending for physicians' services.

However, both bills include provisions on "appropriate use" of imaging and potentially other medical procedures. The bills establish mechanisms for setting appropriate use criteria for imaging services and for tracking how closely physicians adhere to the criteria. Starting in 2020, imaging requests from physicians considered to be "outliers" would be subject to prior authorization. The provisions would also give the HHS Secretary authority to create similar appropriate use programs for other services provided under Medicare Part B, which covers outpatient care, durable medical equipment, home health care, mental health and some other services. ...