This page contains a Flash digital edition of a book.
“I don’t know yet if [these proposals] are going to be the answer. The answer will be fair payment for what we do.”


the program — but it must be done in a fiscally responsible way.”


times that they are reluctant to embrace anything for fear of being disappointed again.” Referring to the revised fiscal estimate, however, he says the time for reform is now. “Clearly there’s an opportunity to do something meaningful, beyond just a one-year patch as has been done in past,” Representative Burgess told Texas Medi- cine. “I’m doing everything I can to make sure we keep this process moving and ultimately get something that’s not just acceptable to doctors, but actually helps patients and physicians and allows the house of medicine to reclaim some of its rightful place in developing and admin- istering these quality measures.” Sen. Max Baucus (D-Mont.), chair of the U.S. Senate Committee on Finance, echoed those sentiments heading into a July hearing on SGR reform. “It is time to repeal this broken formula, and we need to do it this year. But we cannot


just repeal the SGR. We need to change the entire fee-for-service system that Medicare uses to pay physicians.” he said. “Physicians want to improve their performance and efficiency, and Medi- care’s payment policy needs to incentiv- ize that improvement.”


Manuel Acosta, MD


Rep. Michael C. Burgess, MD


34 TEXAS MEDICINE September 2013


Gone for good? Work on the latest proposals dates back to 2011, when lawmakers began exam- ining solutions and soliciting input from the physician community, including TMA and the American Medical Association. “It is clear that the current SGR, should it be allowed to work as designed, threat- ens access to care for millions of seniors in this country, as well as the livelihood of medical providers who care for them,” says a July memo by the House Energy and Commerce Committee. Budget battles still lie ahead, however, as critics continue to question where the money will come from to pay for SGR reform, a peren- nial sticking point in the past. The memo goes on to say that “repeal and replacement of the SGR is a necessary Medicare reform that will ensure the future viability of


Stephen L. Brotherton, MD


In fact, the bill the committee passed does not include a way to pay for itself — a shortcoming that will have to be re- solved before the legislation moves any further. Representative Burgess acknowledges the fiscal barriers, but highlights several factors that differentiate this go-around and brighten the prospects for reform. “Every other time when we started out with ‘How do we come up with money?’ it has not been successful. So we de- cided to do this a different way: Let’s come up with a policy and see if we can get broad agreement on the policy, and maybe that will make the [budget] side of things something people are willing to fight for.” So far, that policy starts out by elimi- nating the SGR by the end of 2013 and providing a five-year period of fee-for- service payments that include an infla- tion update of 0.5 percent per year from 2014 through 2018.


“That in and of itself is bigger and better than anything that has ever hap- pened in an SGR patch in the past,” Rep- resentative Burgess said.


During that timeframe, scheduled


penalties under existing reporting pro- grams would remain, such as the value- based modifier, the Physician Quality Re- porting System (PQRS), and the mean- ingful use of electronic health records. (See “Penalties Add Up,” May 2013 Texas Medicine, pages 35–39.)


Beginning in 2019, the annual fee-


for-service update would continue, but payment incentives and potential penal- ties under a new quality reporting pro- gram also would kick in. During the five- year transition, the bill invites physician organizations to help develop the quality reporting measures to be used, with the goal of building on and eventually re- placing PQRS, while aligning with other quality programs.


The committee memo says the five- year transition period responds to the medical community’s request for enough time to develop and test quality mea- sures and clinical practice improvement activities that would link doctors’ pay to their quality performance.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68