News
A new bipartisan, bicameral plan to repeal the Medicare Sustainable Growth Rate formula has surfaced on Capitol Hill.
On Oct. 30, the Senate Finance Committee and the House Ways and Means Committee jointly released a legislative framework that would scrap Medicare’s Sustainable Growth Rate (SGR) formula and freeze physician payments for the next decade.
Rep. Dave Camp
Starting in 2017, physicians would see their payments tied to cost and quality of care using a single quality incentive program. Under the proposal, Medicare would create the Value-Based Performance Payment Program to adjust physician payments based on quality, resource use, clinical practice improvement activities, and the use of electronic health records.
Since the program is budget neutral, some physicians would see increases while others would see cuts.
At the end of 2016, Medicare would end a group of existing incentive programs including the Physician Quality Reporting System; the Value-Based Modifier Program; and the Electronic Health Record (EHR) Incentive Program, which requires the meaningful use of certified EHR technology.
Physicians who treat few Medicare patients or who receive a significant portion of their payments from advanced alternative payment models, such as accountable care organizations, would be excluded from the new Value-Based Performance Payment Program. Physicians in ACOs and other models that involved taking on financial risk and reporting on quality measures would instead be eligible for bonus payments under the proposal.
After 2023, physicians who participate in these advanced alternative payment models would see an annual 2% payment increase, and other physicians would earn updates of 1% each year, according to the proposal circulated by the two committees.
"This discussion draft is an important step in a long-term solution to this failed policy," Rep. Dave Camp, chairman of the House Ways and Means Committee, said in a statement. "Creating a policy that rewards providers for delivering high-quality, efficient health care is the ultimate goal, and this draft brings us one step closer to that reality."
Dr. Ardis Hoven
The release of the proposal follows a summer of feverish activity in the House on the issue of the SGR. After months of hearings, the Energy and Commerce Committee unanimously approved a bill on July 31 (H.R. 2810) that would repeal the SGR and provide 0.5% payment increases for physicians through 2018.
Momentum slowed after Labor Day with the continuing debate over the Affordable Care Act and the federal government shutdown that began on Oct. 1. This latest plan incorporates ideas from both the Democratic-led Senate and the GOP-controlled House.
While physician groups were still reviewing the proposal at press time, they hailed the renewed focus on the SGR as a move in the right direction.
"Congress is demonstrating that they understand that ending the failed SGR this year is fiscally responsible, and that the current Medicare payment system is a barrier to adoption of health care delivery and payment reforms that will improve health care for America’s seniors and rein in overall costs," Dr. Ardis Dee Hoven, president of the American Medical Association, said in a statement.
Physicians can comment on the proposal until Nov. 12. Send comments to the Senate Finance Committee at sgrcomments@finance.senate.gov and to the House Ways and Means Committee at sgrwhitepaper@mail.house.gov.