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SGR Patched Yet Again

By L. Anthony Cirillo, MD, FACEP | on April 16, 2014 | 0 Comment
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Congress disregards physician community

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In surprising fashion, the U.S. House, followed by the U.S. Senate, passed HR 4302, the Protecting Access to Medicare Act of 2014. The bill has now been signed by into law President Barack Obama. It prevented a 24 percent decrease in Medicare physician reimbursement that was scheduled to kick in on April 1,2014. The law averted the 24 percent cut in exchange for 0.5 percent continued increased payments over 2013 levels through the rest of 2014, but then includes a 0 percent update for the first three months of 2015. While preventing the 24 percent cut was the underlying premise for the law, what else is included and how it will get paid for is definitely more important to physicians in the long run.

Sun Sets on the “Two-Midnight” Rule

By Paul Kivela, MD, MBA, FACEP
On April 1, 2014, President Obama signed the “Doc Fix” (HR 4302) into law. It delayed the Medicare physician payment rates that were due to be substantially cut under the flawed Sustainable Growth Rate formula. This bill also had a provision that delays enforcement of the “two-midnight rule” to March 1, 2015. Although this rule officially took effect Oct. 1, 2013, Medicare had already delayed it through Sept. 20, 2014. Hospitals and physician groups have been continually protesting this law as vague and problematic. It is anticipated that this will give the hospitals, physicians, and CMS more time to work out clarifications and potentially find a compromise.


Dr. Kivela is managing partner at Napa Valley Emergency Medical Group, medical director of Medic Ambulance, and part owner of Elan Medical Corporation. He is also the secretary-treasurer of the ACEP Board of Directors.

The bill that was brought to the House floor came directly from a compromise worked out by House Speaker John Boehner and Senate Majority Leader Harry Reid. The 121-page bill was introduced on the evening of Wednesday, March 26, with a vote scheduled for the very next morning! Many members of congress were unaware that there was a vote scheduled, or what was in the bill, before it hit the House floor. The bill was taken up under a special provision whereby “noncontroversial” bills can be considered and voted on under “suspension of the rules” (e.g., debate limited to 40 minutes and no amendments allowed by members on the floor). But this bill certainly was controversial, as the debate showed. Despite significant “voice” (e.g., voice vote: only the members currently on the floor may vote) objection during a hastily called vote when many members of the House weren’t even in the chamber, the bill was considered “passed” by the House. Despite strong objection from the American Medical Association, ACEP, and the entire organized specialty houses of medicine, the Senate passed the bill and it has now been signed into law.

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Topics: Billing

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About the Author

L. Anthony Cirillo, MD, FACEP

Dr. Cirillo serves on the ACEP Board of Directors. He still actively practices emergency medicine and serves as the director of government affairs for US Acute Care Solutions.

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