The House and Senate committees that oversee Medicare – the Senate Finance Committee, the House Energy and Commerce Committee, and the House Ways and Means Committee – also have been talking to physicians and insurers about what type of payment system could replace the SGR.
Bob Doherty
Committee members appear to be working toward legislation that would extend current Medicare payment rates temporarily while moving toward value-based payment models, according to Bob Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians.
If lawmakers went forward with that type of plan, physicians would probably have the chance to earn a small pay increase for participating in programs that reward value or care coordination. That approach would still leave the SGR in place, though, at least in the short-term.
"The hope is that, as more physicians begin to move to these other models and you get more experience with them, that will create a roadmap to eventually sunsetting the entire SGR and replacing it with these value-based payment models," Mr. Doherty said.
Although the emphasis on getting away from the current system is encouraging, Mr. Doherty said he’s concerned about any approach that falls short of repealing the SGR.
Variety Is Needed
It’s also looking like a plan to replace the SGR could include a variety of payment models, not just a single alternative, said Ray Quintero, director of government relations for the American Osteopathic Association.
"A one-size-fits-all solution is no longer possible," he said. "At the end of the day, every physician practices differently, the patients that they serve are different, the services that they provide are different, and the payment models should be reflective of that."
Some of those new models may come from the Center for Medicare and Medicaid Innovation, which was created under the Affordable Care Act and is testing new ways to pay for and deliver health care, but Congress is also looking to the private health plans for solutions that have already been tested and produced savings, Mr. Quintero said.
Copyright ACC
Dr. William Zoghbi
Time to Act Is Now
Dr. William Zoghbi, president of the American College of Cardiology, said that the problem is urgent and members of Congress need to look to payments models that are ready for implementation today.
The ACC has developed SMARTCare, a program to address variation in cost and quality in the treatment of stable ischemic heart disease. SMARTCare uses registry data to help physicians employ the most appropriate diagnostics and treatments. Such a program could be used hand-in-hand with a bundled payment model, he said.
"There are so many ways of doing it, but I think we really need to get together and make some early decisions to move forward," Dr. Zoghbi said.