Lawmakers Release Plan To Permanently Replace Medicare Pay Formula
Republican leaders of two House committees on Wednesday began circulating among health care providers an updated draft plan to permanently repeal and replace the sustainable growth rate formula, which sets the Medicare physician payment rates, The Hill's "Healthwatch" reports.
The draft plan was developed by House Energy and Commerce Committee Chair Fred Upton (R-Mich.), Ways and Means Committee Chair Dave Camp (R-Mich.) and the committees' health subcommittee chairs, Reps. Kevin Brady (R-Texas) and Joe Pitts (R-Pa.) (Viebeck, "Healthwatch," The Hill, 4/3).
Congress routinely has passed legislation to delay cuts called for by the SGR, but physicians face substantial reductions in their Medicare reimbursements each time the "doc fix" expires. The most recent doc fix delayed the cuts until Jan. 1, 2014, at which time physicians face about a 25% reduction to the Medicare reimbursement rates (California Healthline, 2/14).
The draft sent out this week builds on a previous plan released in February and includes three phases:
- Repeal the SGR and provide fixed payment rates for a still-to-be-determined period;
- Move away from the current fee-for-service system to one that rewards physicians for quality care; and
- After a number of years, build upon improvements by rewarding efficiency through bonus payments for doctors who deliver efficient care.
In an accompanying letter, the lawmakers wrote that the plan also "recognizes the important role that [specialty-specific] registries can play to facilitate quality improvement while minimizing provider participation burden" ("Healthwatch," The Hill, 4/3).
They added that the new draft addresses comments received on the plan released in February emphasizing the need for stability and predictable payments while new payments models are developed.
Officials with the American Medical Association, American Medical Group Association and Medical Group Management Association praised the new plan (Robeznieks, Modern Healthcare, 4/3).
Lawmakers Expect To Move Quickly on Plan
Rep. Michael Burgess (R-Texas) -- chair of the Republican Doctors' Caucus -- said that House GOP leaders are committed to quickly developing an SGR replacement that has bipartisan support and that lawmakers will hold a hearing on the matter within the next two months. However, lawmakers have not yet determined offsets for their plan that would be capable of gaining bipartisan support, Burgess added.
According to estimates released by the Congressional Budget Office earlier this year, repealing the SGR would cost $138 billion over a decade -- more than $100 billion less than previous estimates (Baker, "Healthwatch," The Hill, 4/3).
Meanwhile, Upton said he hopes to introduce a repeal measure on the House floor over the summer (Ethridge, CQ Roll Call, 4/3).
The lawmakers requested feedback on the plan by April 15 (Modern Healthcare, 4/3).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.