House Committee Releases Bipartisan ‘Doc Fix’ Legislation
The House Energy and Commerce Committee on Thursday released bipartisan draft legislation that gradually would repeal the sustainable growth rate formula, which determines Medicare physician reimbursement rates, MedPage Today reports (Pittman, MedPage Today, 7/18).
Congress routinely has passed "doc fix" legislation to delay cuts called for by the SGR, though physicians face substantial reductions in their Medicare reimbursements each time such legislation expires. The most recent doc fix delayed the cuts until Jan. 1, 2014, at which time physicians face about a 25% reduction to Medicare reimbursement rates.
Hopes for a permanent repeal increased in February, after the Congressional Budget Office's budget projections dramatically reduced the cost of eliminating the SGR from about $300 billion over 10 years to $138 billion over 10 years. Although lawmakers have attempted to repeal the SGR for years, efforts have failed because of the high cost.
House Republicans have vowed to mark up legislation to replace the SGR this year and have released a series of draft bills and invited stakeholders' input.
In April, Republicans on two House committees circulated a draft plan that would replace the SGR in three phases, gradually shifting to a reimbursement system that rewards physicians for quality care. In May, the lawmakers released a more-detailed version of that draft plan. However, the May plan did not specify how the changes would be funded.
Several stakeholders criticized the plan -- developed by House Energy and Commerce Committee Chair Fred Upton (R-Mich.) and Ways and Means Committee Chair Dave Camp (R-Mich.) -- because it would not require providers to stop using the current fee-for-service model.
In June, committee leaders released another update to the draft legislation -- described as an advanced "legislative framework" -- that still did not include details about funding. However, Upton in a statement said the "final product will secure a long-term, fully paid for solution that improves quality of care, and, once and for all, removes the gimmicks that have plagued the SGR system" (California Healthline, 7/1).
Bipartisan Draft Legislation
Under the new bipartisan draft proposal, Medicare physician reimbursements would grow by 0.5% annually over five years. Starting in 2019, Medicare would switch to an enhanced fee-for-service system that would provide physicians with updates and payment incentives based on their performance on certain quality measures.
The quality measures -- which would compare physicians with others in their subspecialty -- would be based on:
- Care coordination;
- Clinical care;
- Patient experience;
- Patient population; and
The proposal directs HHS Secretary Kathleen Sebelius to review and finalize the quality measures for the upcoming year by Nov. 15 of each year (MedPage Today, 7/18). Under the proposal, Sebelius also would be required to develop codes for complex chronic care management services and develop a fee schedule for those services starting in 2015.
The draft proposal calls for providing physicians with feedback on their performance in meeting the quality measures in "as real time as possible, but at least quarterly" (Ethridge, CQ Roll Call, 7/18).
The bill would allow physicians to opt out of the fee-for-service system and choose an alternative payment model that emphasizes efficient and quality care, such as:
- Accountable care organizations;
- Bundled payment programs; or
- Patient-centered medical homes (MedPage Today, 7/18).
In addition, CMS would be required to collect recommendations from professional groups on payment bundles for chronic conditions and costly, high-volume services. The bill also includes a provision to expand physicians' access to Medicare data.
Funding Source Remains Unclear
The bipartisan draft bill still does not include full details on how it would offset the cost of repealing the current payment system, CQ Roll Call reports. CBO has estimated the total cost of repealing the SGR would be $139.1 billion over 10 years.
However, the draft bill does authorize transfers from the Medicare Part B trust fund to provide some funding for some of its provisions.
Lawmakers Tout Proposal
Upton and Rep. Henry Waxman (D-Calif.) touted the close collaboration among committee members and industry stakeholders to create the final draft legislation. In a joint statement, Upton and Waxman said, "We have much work to do and will not be satisfied until we have a permanent and responsible SGR fix in place."
Waxman added, "This is a first step and an important one. It undoubtedly can and will be improved as we move through the legislative process, but I believe we already have a stronger product because of our joint effort" (CQ Roll Call, 7/18).
Meanwhile, Rep. Mike Burgess (R-Texas) -- one of the bill's co-sponsors -- praised the committee's efforts saying it is "poised to provide a full repeal of SGR and replace it with a predictable sustainable schedule of updates and a simplification of the reporting of quality measures."
The House Energy and Commerce Health subcommittee is scheduled to mark up the legislation Monday and hold a final vote on Tuesday (MedPage Today, 7/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.