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Washington Debrief: Congress Takes Step Towards SGR Repeal

November 5, 2013
by Jeff Smith, Director of Public Policy at CHIME
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Jeff Smith, Director of Public Policy at CHIME

Congress Takes Significant Step Forward Towards Full Sustainable Growth Rate Repeal While most health policy circles in Washington continued to deal with the fallout of a botched roll-out, congressional staffers this week unveiled a “discussion draft outline” to permanently fix the Medicare Sustainable Growth Rate (SGR) formula. This is significant because it builds on previous bipartisan and bicameral efforts, and thus far, has the support of major provider groups. A joint press release from the House Ways & Means and Senate Finance committees said the new proposal, “Is for a new physician payment system that rewards value over volume. It will go a long way in improving the efficiency and quality of care for America’s seniors.” The major components of the outline include:

  • A ten-year freeze of physician payment updates, with the ability of physicians to receive bonus payments based on performance;
  • Expansion of alternative and advanced payment models, using shared savings programs, bundled payments and medical homes; and
  • Development of “appropriate use criteria” for some procedures.

According to the discussion draft, the Centers for Medicare and Medicaid Service (CMS) would begin adjusting physician payments based on performance in 2017. To gauge performance and allow for increased payments for high-performing physicians, the proposal would use three existing programs, including the Physician Quality Reporting System (PQRS), which imposes a 2 percent payment penalty on physicians who fail to report on quality measures; the Value-Based Modifier, which adjusts payments based on quality and resource use; and the electronic health record (EHR) Meaningful Use program, which penalizes physicians who do not demonstrate meaningful use of electronic records beginning in 2015.

Physicians who obtain a share of their revenues through alternative payment models (APMs) that involve shared risk and quality measurements would receive a 5 percent bonus payment each year from 2016 through 2021. After 2021, the plan is that most physicians will have adapted their practices to be more efficient so that payment models become self-sustaining.

Public comment is welcome on the draft through Nov. 12. CHIME will monitor this important advance toward a full repeal of the current Medicare fee-for-service payment model.

Meaningful Use Stage 3 Conversations Turn to Public Health Reporting  During a Meaningful Use workgroup meeting of the Health IT Policy Committee last week, public health reporting and the associated technical infrastructure needed to support reporting topped the agenda. Based on working recommendations, MU Stage 3 will require eligible hospitals and eligible professionals to participate in public health and/or professional registry reporting to a much higher degree than Stage 2 requires.

Conversations in Washington indicate that EHs and EPs would be required to submit standardized initial case reports to public health agencies on 10 percent of all reportable disease or conditions, workgroup documents indicate. Likewise, recommendations under consideration would require submission of data on at least 10 percent of patients that meet registry inclusion criteria.

However, workgroup discussion focused on the fractured landscape of public health data standards and disparities in jurisdictional capacity to accept such data. The Health IT Standards Committee is reportedly working on a way to coalesce all of the jurisdictions together on a website that provider EHRs could use to customize case reporting at the regional level. Agencies could then list their jurisdiction and related standards on an external site that an agency, such as the Centers for Disease Control and Prevention, could host.

The MU workgroup plans to present recommendations on meaningful use Stage 3 on Dec. 4.

Telehealth Bills Receive Broad Support from Provider Community As part of an effort to address staffing shortfalls in healthcare, a bipartisan group of House members introduced the Telehealth Enhancement Act of 2013 last week. The bill is sponsored by Reps. Gregg Harper (R-Miss.), Devin Nunes (R-Calif.), Mike Thompson (D-Calif.) and Peter Welch (D-Vt.).

The main provisions of the bill would: