I 
109TH CONGRESS 
1ST SESSION H. R. 2356 
To amend title XVIII of the Social Security Act to reform the Medicare 
physician payment update system through repeal of the sustainable 
growth rate (SGR) payment update system. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 12, 2005 
Mr. SHAW (for himself and Mr. CARDIN) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committee on Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to reform 
the Medicare physician payment update system through 
repeal of the sustainable growth rate (SGR) payment 
update system. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Preserving Patient Ac-
cess to Physicians Act of 2005’’.
SEC. 2. REFORM OF THE MEDICARE PHYSICIAN PAYMENT 
UPDATE SYSTEM THROUGH ELIMINATION OF 
THE SUSTAINABLE GROWTH RATE (SGR) PAY-
MENT UPDATE SYSTEM. 
(a) IN GENERAL.—Section 1848(d) of the Social Se-
curity Act (42 U.S.C. 1395w–4(d)) is amended by adding 
at the end the following new paragraphs: 
‘‘(6) UPDATE
FOR
2006.—The update to the 
single conversion factor established in paragraph 
(1)(C) for 2006 shall not be less than 2.7 percent. 
‘‘(7) UPDATE
FOR
YEARS
BEGINNING
WITH 
2007.— 
‘‘(A) IN GENERAL.—Unless otherwise pro-
vided by law, subject to the budget-neutrality 
factor determined by the Secretary under sub-
section (c)(2)(B)(ii), the update to the single 
conversion factor established in paragraph 
(1)(C) for a year beginning with 2007 is equal 
to the product of— 
‘‘(i) 1 plus the Secretary’s estimate of 
the percentage change in the value of the 
input price index (as provided under sub-
paragraph (B)(ii)) for the year (divided by 
100); and
‘‘(ii) 1 minus the Secretary’s estimate 
of the productivity adjustment factor under 
subparagraph (C) for the year. 
‘‘(B) INPUT PRICE INDEX.— 
‘‘(i) ESTABLISHMENT.—Taking into 
account the mix of goods and services in-
cluded in computing the medicare economic 
index (referred to in the fourth sentence of 
section 1842(b)(3)), the Secretary shall es-
tablish an index that reflects the weighted- 
average input prices for physicians’ serv-
ices for a year. Such index shall only ac-
count for input prices and not changes in 
costs that may result from other factors 
(such as productivity). 
‘‘(ii) ANNUAL ESTIMATE OF CHANGE 
IN INDEX.—The Secretary shall estimate, 
before the beginning of each year (begin-
ning with 2007) the change in the value of 
the input price index under clause (i) from 
the previous year to the year involved. 
‘‘(C) PRODUCTIVITY
ADJUSTMENT
FAC-
TOR.—The Secretary shall estimate, and cause 
to be published in the Federal Register not 
later than November 1 before the beginning of
each year (beginning with 2007), a productivity 
adjustment factor that reflects the Secretary’s 
estimate of growth in multifactor productivity 
in the national economy, taking into account 
growth in productivity attributable to both labor 
and nonlabor factors. Such adjustment may be 
based on a multi-year moving average of pro-
ductivity (based on data published by the Bu-
reau of Labor Statistics).’’. 
(b) CONFORMING AMENDMENTS.—Section 1848 of 
the Act (42 U.S.C. 1395w–4) is amended— 
(1) in subsection (d)(1)(A), by striking ‘‘sub-
paragraph (B))’’ and all that follows and inserting 
the following: ‘‘subparagraph (B))— 
‘‘(i) for years before 2001, adjusted 
by the update (established under para-
graph (3)) for the year involved; 
‘‘(ii) for 2001, 2002, and 2003, multi-
plied by the update (established under 
paragraph (4)) for the year involved; 
‘‘(iii) for 2004 and 2005, multiplied 
by the update (established under para-
graph (5)) for that year;
‘‘(iv) for 2006, multiplied by the up-
date (established under paragraph (6)) for 
that year; and 
‘‘(v) for 2007 and each subsequent 
year, multiplied by the update (established 
under paragraph (7)) for the year in-
volved.’’; 
(2) by striking clause (i) of subsection 
(d)(1)(E) and inserting the following: 
‘‘(i) cause to have published in the 
Federal Register not later than November 
1— 
‘‘(I) of 2000 and each subsequent 
year, the conversion factor which will 
apply to physicians’ services for the 
succeeding year; 
‘‘(II) of 2000, 2001, and 2002, 
the update determined under para-
graph (4) for such succeeding year 
and the allowed expenditures under 
such paragraph for the succeeding 
year; 
‘‘(III) of 2003 and 2004, the up-
date determined under paragraph (5) 
for 2004 and 2005;
‘‘(IV) of 2005, the update deter-
mined under paragraph (6) for 2006; 
and 
‘‘(V) of 2006 and each subse-
quent year, the update determined 
under paragraph (7) for the suc-
ceeding year; and’’; 
(3) in subsection (d)(1)(E)(ii), by inserting 
‘‘(for years before 2006)’’ after ‘‘the sustainable 
growth rate’’; 
(4) in subsection (d)(4)— 
(A) in the heading, by striking ‘‘YEARS 
BEGINNING WITH 2001’’ and inserting ‘‘2001, 
2002, AND 2003’’ ; 
(B) in subparagraph (A), in the matter 
preceding clause (i), by striking ‘‘for a year be-
ginning with 2001’’ and inserting ‘‘for 2001, 
2002, and 2003’’; 
(C) in subparagraph (C)(iii), by striking 
‘‘YEARS
BEGINNING
WITH
2000.—The al-
lowed expenditures for a year (beginning with 
2000)’’ and inserting ‘‘2000, 2001, AND 2002.— 
The allowed expenditures for each of years 
2000, 2001, and 2002’’; and
(D) in subparagraph (E), by striking ‘‘BE-
GINNING WITH 2001’’ and ‘‘for a year begin-
ning with 2001’’ and inserting ‘‘2001, 2002, AND 
2003’’ and ‘‘for 2001, 2002, and 2003’’, respec-
tively; and 
(5) in subsection (f)— 
(A) in paragraph (1)(B), by striking ‘‘No-
vember 1 of each succeeding year’’ and insert-
ing ‘‘November 1 of each year before 2005’’; 
(B) in paragraph (2), by inserting ‘‘and 
ending with 2003’’ after ‘‘beginning with 
2000’’; 
(C) in paragraph (3), by striking ‘‘for a 
year beginning with 2001’’ and inserting ‘‘for 
2001, 2002, and 2003’’; and 
(D) in paragraph (3)(C), by striking ‘‘FOR 
2003 AND SUCCEEDING YEARS’’ and inserting 
‘‘FOR 2003’’ and by striking ‘‘a year after 2002’’ 
and inserting ‘‘2003’’. 
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