On Wednesday morning, March 26, the House of Representatives passed a bill that would permanently repeal the sustainable growth rate (SGR) formula, which governs how physicians are reimbursed under the Medicare program.
With nearly 400 affirmative votes, the bill now moves to the Senate. If it passes the Senate, it will be up to President Barack Obama to sign the deal. According to media reports, the President has indicated that he would sign the legislation.
Sources with close Congressional ties tell Healthcare Informatics that there is a strong chance the bill will pass the Senate, though the Senate vote may not take place until Saturday, March 28.
The bill would repeal the SGR and institute a 0.5 percent payment update each year for five years. The SGR has been permanently patched 17 times in 11 years. The latest version is set to expire on March 31st.
Moreover, the bill would move healthcare further down the path of value-based reimbursement.Under the new “MIPS,” or Merit-Based Incentive Payment System, to be applied to payments beginning Jan. 1, 2019, the Secretary of Health and Human Services would “assess appropriate adjustments to quality measures, resource use measures, and other measures used under the MIPS; and… assess and implement appropriate adjustments to payment adjustments, composite performance scores, scores for performance categories, or scores for measures or activities under the MIPS.”
Those would include clinical quality, resource use, clinical practice improvement (including care coordination and improvement activities), and the meaningful use of certified EHR (electronic health record) technology. This includes layers of detail, such as care coordination efforts through “timely communication of test results, timely exchange of clinical information to patients and other providers, and use of remote monitoring or telehealth,” and the engagement of patients as well.
On top of these side effects, it would also have a direct effect on health IT in that it would alter the meaningful use program. Specifically, it would consolidate meaningful use, the Medicare Physician Quality Reporting System (PQRS), and Medicare Value Modifier program. It also establishes metrics that would push forward interoperability of electronic health record (EHR) systems.
In anticipation of the House passing the bill, the Medical Group Management Association immediately heaped praise the politicians. “The House of Representatives has voted to remove the dark cloud of financial uncertainty over physician group practices. Medicare innovation has been hampered far too long by the SGR. The Senate is one vote away from returning stability to patients and physicians in Medicare. MGMA urges the Senate to immediately vote to repeal the SGR,” Halee Fischer-Wright, M.D. President and CEO of MGMA, said in a statement.
MGMA is one of many provider-focused advocacy groups that are in favor of the bill, including the American Medical Association. Not everyone is on board though. The Committee for a Responsible Federal Budget, a nonprofit bipartisan organization, and The Heritage Foundation, a nonprofit conservative think tank, say it would add billions to the federal deficit.
Healthcare Informatics will have more on this developing story.