A bipartisan bill in the U.S. House of Representatives may finally fix a flaw in how Medicare pays physicians by basing more of their reimbursement on performance and quality measures.
Doctors say the flaw has triggered thousands of physicians to flee the Medicare health insurance program for the elderly in recent years.
But House members this week released a final draft of legislation that will repeal Medicare’s “sustainable growth rate,” or SGR, reimbursement formula. Doctors have long been upset at the lack of a permanent solution for dramatic cuts to doctor payments from Medicare in what has since been labeled the “doc fix.”
Congress earlier this year – as it has several times for a decade now — merely made stopgap corrections to avert drastic payment cuts to Medicare payments under SGR, which was created by the Balanced Budget Act of 1997 in an effort to slow the growth of Medicare spending. This year alone, Congress averted a fee cut of nearly 27 percent to physician payments.
The new legislation, which has key Democratic and Republican support in the U.S. House, would increase payments 0.5 percent annually starting next year and run through 2018. A House Committee vote could come next week.
By 2019, more fee-for-service payments would be tied to quality measures that include “clinical care, safety, care coordination, patient and caregiver experience and population health.” To get bonus payments, physicians would be compared to their peers and measures would be updated each November by the U.S. Secretary of Health and Human Services.
Physician groups were pleased to see movement.
Dr. Ardis Hoven, president of the American Medical Association, called the work to repeal SGR by the House Energy and Commerce Committee “continued progress, though work remains to be done.”
Still, the AMA and other doctor groups, including the American Academy of Family Physicians, said they supported moving to payment models that lowered health care costs and improved quality.
“Physicians want to move past the failed SGR formula and toward a Medicare program that supports the best health outcomes for their patients and provides a stable, rewarding practice environment,” Hoven said.
The move to new payment could also be good news to the health insurance industry with companies like Aetna AET +0.4% (AET), UnitedHealth Group UNH -0.22% (UNH), Humana HUM +1.08% (HUM) and others seeing greater numbers of seniors flocking to their Medicare Advantage plans that contract with the Medicare program to provide seniors with health benefits. They need doctors to participate if they are going to provide seniors with adequate medical care provider networks.
“We are pleased to announce a significant, bipartisan milestone in our effort to fix the broken SGR system,” said House Energy and Commerce Committee Chairman Fred Upton, (R-Michigan) and Health subcommittee chairman Joe Pitts (R-Pa) in a joint statement. “We remain steadfast in our goals for reform: a fair system for our seniors and their doctors that provides the highest quality of care; bipartisan support, achieved through a transparent, deliberative process; and paid for in a fiscally responsible manner.”
Meanwhile, Democratic Rep. Frank Pallone, co-author of the legislation, said “it is critical that we drive quality and value rather than volume into Medicare.”
http://www.forbes.com/sites/brucejapsen/2013/07/20/congress-may-finally-fix-medicare-payment-flaw-avert-doctor-exodus/?goback=%2Egde_4245113_member_259702108
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