Economics BY AMY LYNN SORREL
SGR is gone. Now what?
PREPARING FOR MEDICARE’S NEW PAYMENT PARADIGM
S
ooner than later, physicians will have to prepare for participation in one of the new quality-focused payment pathways set to replace Medicare’s Sustainable Growth Rate (SGR) formula, which Congress eliminated in
April via the Medicare and CHIP Reauthorization Act (MACRA). The key word is options, which the new payment paradigm offers, thanks to footprints left by the law’s primary author and sponsor, Texas Congressman Rep. Michael C. Burgess, MD, a Republican obstetrician-gynecologist from Lewisville. Come 2019, physicians can participate in one of two major payment tracks: the fee-for-service Merit-Based Incentive Payment System (MIPS), which boosts or docks physician pay based on their quality and cost performance; or one or more alternative payment models (APMs), such as accountable care organizations (ACOs), medical homes, bundled payments, or other initiatives. Texas Medical Association officials caution that physicians won’t be able to
wait until 2019 to flip a switch, now that Medicare calculates payments based on their performance from two years earlier, in this case, 2017. Physicians also must consider the time and tools it takes to begin tracking practice data or transition- ing to an APM leading up to the performance year. (See “Post-SGR Timeline,” pages 58-59.) With plenty of federal rulemaking ahead to fully define and implement MA-
CRA, early physician involvement is also critical to fine-tuning some of the law’s less palatable provisions, warns a June report from The Physicians Foundation. To read the full report, visit tma.tips/MedicareWatchList. “We are celebrating, and we needed this [SGR] victory. But we can’t just sit
on this victory. We are not nearly done. We are just beginning,” said Joseph Valenti, MD, a member of The Physicians Foundation board and chair of TMA’s Council on Socioeconomics. “Practices that don’t stay on top of these regulatory changes are very likely not going to survive. That’s why the foundation commis- sioned this report, to help physicians all over the country understand and stay active in these issues. That’s where TMA PracticeEdge [TMA’s physician ser- vices organization] comes in, to make sure physicians are leading these models. [See “TMA PracticeEdge,” page 58.] And that’s why being a part of TMA is so important. Having physician input in what is ahead is as important as getting rid of SGR itself.” Asa C. Lockhart, MD, a Tyler anesthesiologist and past chair of TMA’s Ad Hoc Committee on ACOs, adds MACRA is more than likely here to stay, given the overwhelming bipartisan support for the law. The shift is approaching rapidly, he says, and goes beyond Medicare, too. Commercial payers generally follow Medicare’s lead, many of which already
September 2015 TEXAS MEDICINE 57
“Getting rid of the [SGR] uncertainty was very important.
But it’s not all wine and
roses now.”
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