House Subcommittee Advances ‘Doc Fix’ Legislation
On Tuesday, the House Energy and Commerce Health Subcommittee advanced legislation that gradually would repeal the sustainable growth rate formula, which determines Medicare physician reimbursement rates, The Hill's "Healthwatch" reports (Viebeck, "Healthwatch," The Hill, 7/23).
Under the bipartisan 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 also directs HHS Secretary Kathleen Sebelius to review and finalize the quality measures for the upcoming year by Nov. 15 of each year. In addition, the HHS secretary 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."
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.
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 legislation still does not include full details on how it would offset the cost of repealing the current payment system. 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 (California Healthline, 7/19).
Panel Adds Technical Amendment, Democrats Voice Concerns
Before passing the draft measure via voice vote, the subcommittee approved an amendment -- proposed by Reps. Michael Burgess (R-Texas) and Frank Pallone (D-N.J.) -- that makes technical and conforming changes to the draft bill, such as substituting the term "core measures" for "quality measures." According to Burgess, the changes were made based on feedback CMS received on the draft measure and do "not change any intent or scope of the underlying policy from the circulated draft."
Meanwhile, Democrats detailed changes they would like to make to the bill before it is finalized, although they did not offer any formal amendments. For example, several Democrats said they would like to include increased payment rewards for primary care services included in the measure, and Rep. Lois Capps (D-Calif.) said she would like to include language that permits certified non-physicians to participate in approved coordinated-care models.
Other Democrats -- including Reps. Eliot Engel (D-N.Y.) and Jan Schakowsky (D-Ill.) -- said they would reject the measure if it contained certain offsets, such as shifting costs to Medicare beneficiaries (Ethridge/ Ross, CQ Roll Call, 7/23).
The measure now moves to the full House Energy and Commerce Committee. According to "Healthwatch," the committee could advance the bill before the August recess, but the measure is unlikely to see a full House vote in the next two weeks ("Healthwatch," The Hill, 7/23). Other changes could come after an expected Senate version of the bill is publicly released.
Medical Groups Express Support for Draft Bill, Voice Hesitations
Nearly 20 medical groups have written letters of support for the legislation, according to the Energy and Commerce Committee, MedPage Today reports. However, nearly all of the letters have noted that the bill needs further work before a final version is signed into law (Pittman, MedPage Today, 7/23).
American Medical Association President Ardis Hoven in a statement said, "There is clear bipartisan support for fixing this failed formula and making improvements in the program, but the details matter considerably, and there is still work to be done to ensure a strong future for Medicare." She said quality reporting requirements should be made to build on the existing system and recommended that payments be sufficient enough to allow providers to invest in new care methods (CQ Roll Call, 7/23).
The American Academy of Family Physicians expressed concern that the pay raises did not adequately reimburse physicians, while the American College of Physicians noted that the 0.5% annual update between 2014 and 2015 failed to account for inflation. ACP called on Congress to monitor patient access to determine whether the payments should be increased.
In addition, several groups voiced concerns about the as-yet unspecified quality measures that would be used to determine bonuses and penalties in 2019, while others -- included the American Association of Neurological Surgeons -- questioned how the quality reporting program would mesh with the existing quality reporting systems, such as the Physician Quality Reporting System and Value-Based Payment Modifier (MedPage Today, 7/23).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.