Bipartisan Hill Plan Would Shift Physician Payment Plan
By Christine Kern, contributing writer
Hill Plan would repeal SGR, replace it with payment updates, value-based care
By Christine Kern, contributing writer
Modern HealthCare reports that Congressional lawmakers have unveiled a bicameral, bipartisan agreement to repeal Medicare's physician payment formula and replace it with a system that would provide stable payment updates for five years and shift Medicare to a system based on value versus volume of care.
The deal is the combined effort of three congressional committees—Senate Finance, House Ways and Means, and House Energy and Commerce—working to eliminate Medicare's sustainable growth-rate formula and offer incentives for Medicare-participating physicians to move to alternative payment models.
Called the SGR Repeal and Medicare Provider Payment Modernization Act, the legislation would permanently repeal the SGR and provide an annual update of 0.5 percent from 2014 through 2018. The 2018 payment rates would be maintained through 2023 so physicians have time to receive additional payments through a merit-based incentive payment system.
Lawmakers still need to work out details concerning how they would cover the agreement's cost to repeal and replace the SGR, which is about $126 billion over 10 years, according to a GOP aide.
Rep. Joe Pitts (R-PA), chairman of the House Energy and Commerce Health Subcommittee, said, “This proves that the two parties and the two chambers can work together when policy is put before politics. We are, however, only half way there. We only have agreement on policy. “We still have to figure out how to pay for it, and I am under no illusions about how difficult that may be. We are going to do our best. We've already done more than most people thought was possible."
Established in 1997, the SGR was designed to control physician spending, but Congress has spent about $150 billion since 2003 to provide short-alternatives to a huge Medicare payment cut each year that physicians say would compromise how they treat patients and do business. If Congress passes legislation to permanently eliminate the SGR, Medicare-participating physicians would avert the 23.7 percent payment cut scheduled to kick in April 1.
Dr. Ardis Dee Hoven, president of the American Medical Association, congratulated lawmakers for finding common ground on a contentious issue that has bedeviled lawmakers for years, saying, “This legislation is the product of months of unprecedented bipartisan, bicameral work to reach this landmark agreement to build a stronger Medicare program. Throughout the legislative process, the bill authors have been receptive to AMA's recommendations to improve the policy.”
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