Right now an SGR fix is closer to reality than ever after
yesterday’s unanimous vote by the US House Energy and Commerce Committee on HR 2810, a bill that repeals SGR
along with a number of other measures to reform the Medicare physician payment
system. The bill will now be considered
by the full House, and should it pass would then receive Senate
consideration. Early indicators from
both Democrat and Republican Senate leadership suggest that this bill should be
well received.
In addition to ending SGR immediately, which means that the
25-30% cut that physicians have been facing each year would be eliminated, HR
2810 begins a slow transition to steer Medicare payment away from volume and
towards value. To help stabilize
Medicare payments, the legislation would bump physician pay up 0.5% each year
from 2014 to 2018. Then, in 2019,
payment adjustments would begin to physicians based upon how they compare with
peer physicians on yet-to-be determined quality metrics. The physicians who compare well would see
higher payment increases, while those who fare poorly would receive cuts in
their Medicare reimbursement. Physicians
who choose not to participate in the incentive program will initially receive
an automatic cut of 5%.
The real crux of the bill is obviously slanted towards what
House authors of the legislation are calling “Alternative Payment Models.” A 0.5% increase will likely not keep up with
medical inflation, and coupled with the uncertainty over how physicians will be
measured for quality updates starting in 2019 there is significant pressure for
physicians to consider alternatives to fee-for-service. This bill would allow physicians who come up
with new payment and delivery models to have a streamlined process for approval
from CMS, so that they can be creative and be paid differently by
Medicare. Examples of Alternative
Payment Models are accountable care organizations (ACO’s), patient-centered
medical homes (PCMH), and bundled payments.
For physicians who choose these or other alternative methods of payment,
they can operate outside of the 0.5% increases and quality measurement
system. Of course, any new payment
method will have quality involved, but the upside to physicians developing
their own models is they are determining the quality metrics instead of a
third-party payer like CMS.
This bill also introduces new payment codes for complex care
management, allows physicians easier access to data so that they can develop
new payment and delivery models, and calls for more accuracy in Medicare
payments by incentivizing physicians to report their actual time spent on
various visits and procedures.
Additionally, and not insignificantly, the bill protects physicians from
tort liability for failure to follow medical standards set by the Affordable
Care Act or any other federal legislation by declaring that any standards set
by the federal government are not by default an establishment of the standard
of care owed by a physician to a patient.
There are still a number of steps that this legislation must
go through before final passage, and there are still some kinks that must be
worked out along the way, but the SGR fix alone in this bill is an exciting
prospect for physicians. Whether the
value-based payment structures that the bill encourages will be embraced by
physicians remains to be seen, but the way it is currently structured at least
gives physicians the opportunity to have a say in how they are paid. Those who jump on this opportunity may have
more ability to determine their own future reimbursement; those who do not will likely have their
reimbursement decided by someone else.
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