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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 Healthcare.gov 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:

  • Adjust Medicare home health payments to account for remote patient monitoring;
  • Expand telehealth coverage to all critical access and sole community hospitals;
  • Cover home-based video services for hospice care, home dialysis and homebound Medicare beneficiaries; and
  • Allow state Medicaid programs to set up high-risk pregnancy networks.

“These efforts began with a conversation about physician shortages and concerns with patients’ access to quality and affordable health care,” the authors said in a letter urging their colleagues to co-sponsor the bill. “Until we are able to attract more physicians to rural communities and tighten the access gap, the next best alternative is to use technology to connect health professionals with underserved populations – rural and urban – through telehealth networks.”

This legislation joins the TELEhealth for MEDicare (TELE-MED) Act of 2013, also sponsored by Rep. Nunes, which would primarily enable Medicare providers to treat patients electronically across state lines without having to obtain multiple state medical licenses. More than 60 organizations have voiced their support for the TELE-MED Act.

Hospitals Must Attest by Nov. 30 to Receive Payment for 2013 EHR Incentive Program Participation The last day that eligible hospitals and critical access hospitals (CAHs) can register and submit attestation in fiscal year (FY) 2013 for the Medicare EHR Incentive Program is Nov. 30, 2013. Eligible hospitals and CAHs must successfully attest to demonstrating meaningful use by Nov. 30 to receive a 2013 incentive payment. Hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment, which will be applied beginning FY 2015 (Oct. 1, 2014) to Medicare eligible hospitals that have not successfully demonstrated meaningful use. The adjustment is determined by the hospital’s reporting period in a prior year.

Read the eligible hospital payment adjustment tip sheet to learn more.

Edited for publication by Gabriel Perna


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