Lawmakers in Washington DC are working hard this year to repeal the sustainable growth rate (SGR) formula used to determine payment under the Medicare Physician Fee Schedule (MPFS), that does include outpatient therapy services. A major stumbling block in the repeal is the additional cost to the Medicare program that would occur due to the repeal. Due to the Statutory Pay-As-You-Go Act, Congress must ensure that most new spending is offset by spending cuts or added revenue elsewhere. H.R. 2810, the Medicare Patient Access and Quality Improvement Act, adds several new items of spending without offering ways to pay for the additional spending. If the SGR is not corrected by the end of 2013, Congressional action will be required to halt the roughly 25% reduction in payment in 2014 for services reimbursed under the MPFS.
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