the personnel to do care coordination, or the technology and resources available to provide innovative care in the way they want to when [Congress’ inaction] has pulled the carpet out from under their feet?” Lawmakers sweetened the deal by heeding medicine’s call to delay ICD-10, but the patch nonetheless remains frustrat- ing, she said. “If you’ve got a bunch of lemons, you’re going to make lemonade out of it.”
A new future? But neither physicians nor lawmakers want to see the work done so far go sour. Mr. Whitehurst says the comprehensive SGR repeal leg-
islation remains alive until January 2015, when the current congressional session adjourns, and provides a “good founda- tion” for future discussions. Texas champions like Representa- tive Brady helped smooth some rough edges of early propos- als with medicine’s recommendations, and future regulatory processes could present similar opportunities. “At least this [bill] gets us over the SGR hump,” Mr. Whitehurst said. The proposal generally re- flects a set of core reform princi- ples that AMA, TMA, and other state and national medical so- cieties have advocated to Con- gress for transitioning from the SGR to a new “high-performing” Medicare system. Log on to the TMA website at www.texmed .org/SGR_Transition to read the TMA/AMA letter to Congress. The first thing the bill would
flexibility, at least in the short term, says Donna Kinney, direc- tor of research and data analysis in TMA’s Medical Economics Department.
Physicians would still use programs like PQRS but would have a broader range of measures to meet their quality re- quirements, such as providing after-hours care, she says. Pen- alties under the current programs, which could add up to as much as 6 percent of physician pay for noncompliance, would sunset in 2017. And while penalties under the new system would still exist, the bill added more funds for possible incen- tive payments for their quality improvement efforts and for small practices to implement the MIPS changes. The bonuses and penalties would range from 4 percent in 2018 to 9 percent in 2021 and beyond. At medicine’s urging, the bill also invites physician orga- nizations to help develop the quality reporting measures to be used.
“It’s not sustainable for physicians’ costs to go up every year and for their payment to stay the same.”
do is repeal the SGR, followed by a five-year period of fee- for-service payments that include an inflation update of 0.5 percent per year from 2014 to 2018. The repeal is “the biggest change, and I’m immobile on that. This is not just reforming the SGR. It has to go,” Representative Burgess said. He acknowledges medicine’s concerns that the fee update is not necessarily generous, considering how long physicians have endured payments that lag behind the cost of care. But it eliminates the threat of cuts and represents a compromise that he calls “pretty close” to the Medicare Economic Index, which measures the change in the costs of running a medical practice, including wages, office expenses, and professional liability insurance, for example. Following the transition period, in 2018 Medicare would
begin to modify physician payments under a new merit-based incentive payment system (MIPS) that links a portion of doc- tors’ pay to their quality performance. The MIPS would con- solidate the three existing federal quality reporting programs — the Physician Quality Reporting System (PQRS), meaningful use of electronic health records, and the value-based payment modifier — a shift that could help reduce physicians’ compli- ance and reporting costs and offer fewer penalties and more
“Doctors know quality more than the bureaucracy, so doc- tors need to be involved in that,” Representative Burgess said. And physicians could opt to re- main in fee-for-service Medicare, but they could qualify for additional bo- nus payments of up to 5 percent by participating in alternative payment models such as medical homes or ac- countable care organizations. In urging Congress to move the
ball forward, TMA continues to ad- vocate for improvements that ensure any new payment system keeps up with physicians’ cost of providing care without additional burdens and unwarranted penalties. The legisla-
tion may not be perfect, but “represents a marked improve- ment over the status quo,” TMA and other members of the Coalition of State Medical Societies told congressional leaders in a February support letter. Representatives Brady and Burgess say their goal is to get the bill across the finish line this year, before the current patch expires.
“It’s critical to access. It’s critical to long-term Medicare re- form. And we are not going to be able to deal with other areas of health care that need our attention until this gets resolved,” Representative Brady said. Congressman Burgess added that “there was at least a tacit
agreement by leadership that we are not finished working on this, and we are not going to put this back on the shelf for the next 12 months. That would be the missed opportunity.” n
Amy Lynn Sorrel is associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
June 2014 TEXAS MEDICINE 27
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