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Specialty alliance lays out requests for pay fix


The push to reform Medicare’s sustainable growth rate (SGR) formula continues in Washington, with support for SGR repeal coming from leading House of Representatives committees.

Washington-The push to reform Medicare’s sustainable growth rate (SGR) formula continues in Washington, with support for SGR repeal coming from leading House of Representatives committees. Meanwhile, physician groups are encouraging Congress to make another important change in Medicare policy-to allow beneficiaries and non-participating physicians to freely contract for covered Medicare services without penalty.

On the SGR front, the Alliance of Specialty Medicine, which includes the AUA, in a letter urged key committees in the House to consider several points as it works toward SGR repeal.

The Alliance’s letter was in response to a proposal developed by the House Ways and Means and Energy and Commerce Committees and their respective health subcommittees and circulated among physicians’ organizations for comment.

The Alliance told lawmakers that any physician payment reform proposal should include:

  • repeal of the SGR, followed by a minimum 5-year period of stability in Medicare physician payment

  • physician-led quality improvement that allows the medical profession and medical specialties to determine the most appropriate and clinically relevant quality improvement metrics and strategies for use in future quality initiatives

  • positive financial incentives rather than penalties and withholds

  • elimination of penalties and cumbersome reporting requirements associated with current federal quality reporting programs, such as the Physician Quality Reporting System (PQRS), EHR Incentive Program, and Value-Based Modifier, while allowing physicians and specialties to retain elements that are appropriate and relevant for use in any new quality improvement program


House committees back SGR repeal

In contrast, the proposal from the two House committees calls for:

  • repealing the SGR, thereby eliminating the scheduled 24.4% across-the-board cut in Medicare reimbursements

  • establishing a period of stable payments so providers can prepare for payment changes

  • engaging providers in efforts to improve, reform, and update reimbursement systems

  • empowering providers and other relevant stakeholders to determine the measures of quality and efficiency that are meaningful for Medicare beneficiaries

  • establishing a more reasonable time frame for developing measures that promote value

In introducing their revised proposal, the committee chairs called reforming the SGR their “top priority” and said they “recognize that the uncertainty over potentially devastating reimbursement cuts makes it difficult for practices to plan for the future… hire necessary staff, and make investments in practice improvement.”


AUA supports contracting bill

Meanwhile, the Alliance, with the AUA’s support, has expressed its support of the Medicare Patient Empowerment Act, sponsored in the House by Rep. Tom Price, MD (R-GA), and in the Senate by Sen. Lisa Murkowski (R-AK). The bill focuses on the request for private contracting.

Under current law, Medicare beneficiaries who choose to see non-participating physicians are required to pay the physician’s fee entirely out of personal funds, with no help from Medicare. In addition, physicians who choose to provide covered services to Medicare beneficiaries under private contracts must “opt out” of Medicare for 2 years, during which time Medicare does not pay the physician for any covered services provided to Medicare beneficiaries.

“These discriminating policies are inappropriate and prevent beneficiaries from seeking care from the physician of their choice,” the Alliance letter to Rep. Price said. “Seniors… deserve to get what they were promised-a Medicare benefit that allows them access to the physician of their choice, even if he or she is no longer accepting Medicare. Unfortunately, under current law, they cannot.”

The Alliance pointed out that the SGR worsens the situation as the baby boom generation enters Medicare even as fewer physicians accept Medicare patients because of the growing gap between Medicare payment rates and the cost of running a practice.

The Alliance also said many physicians are reconsidering participation in Medicare “as they face an increasing number of regulations and penalties for failing to comply with meaningful use, quality reporting, and documentation requirements.”

Last December, the American College of Radiology’s Harvey L. Neiman Health Policy Institute warned that physicians could lose up to $1.3 billion per year from Medicare by not satisfactorily reporting quality measures under PQRS.

All of these pressures demand Medicare payment system reform, the Alliance said, adding that an “essential element” should include allowing patients and physicians to voluntarily enter into private contracts, with Medicare “paying its fair share” and the patient responsible for the balance.

“Ultimately, private contracting is the only way to ensure that our patients can maintain control over their own medical decisions,” the Alliance said. “While the government may have the right to determine what it will pay toward medical care, it does not have the right to determine the value of that medical care.”UT

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