On July 9, leaders at the Charlotte-based Premier healthcare alliance submitted comments to the House Energy and Commerce Committee, with regard to members of the U.S. House of Representatives now considering how to solve what is commonly known as the “SGR problem.” The term refers to the sustainable growth rate under Medicare, and the fact that for several years in a row, the U.S. Congress has continued to “patch” that rate, meaning that the legal requirement to institute payment cuts to physicians under Medicare, has continued to be temporarily averted. The amount of federal money involved now is in the hundreds of billions, and a 25-percent physician reimbursement cut under Medicare looms for next year.
In a letter to Rep. Fred Upton, chairman of the Committee on Energy and Commerce, and Joe Pitts, chairman of the Subcommittee on Health of the Committee on Energy and Commerce, Blair Childs, senior vice president, public affairs, at Premier, urged lawmakers to make sure that any “SGR fix” move forward to tie payment to outcomes measurement, to align with the federal Physician Quality Performance System (PQRS), and to be linked to the Department of Health and Human Services’ National Quality Strategy. As Childs wrote, in reference to questions that had been asked by members of the house, “Question #1 asks about how best to tie quality performance to payment. In addition, Attachment A describes two proposed payment scenarios for the Update Incentive Program, the “Threshold” or “Benchmark” Model and the Percentile Update Incentive Payment Model. The Premier alliance recommends the first approach,” Childs wrote, “since it provides appropriate incentives for all physicians to improve their performance. In contrast, the second approach guarantees that some portion of the physician community, such as physicians scoring at or below the 25th percentile on some benchmark, ust always incur a payment penalty of some kind,…”
Further, Childs urged the chairmen, “Question #7 asks whether the new quality system should align and coordinate with PQRS. The Premier alliance believes this would be extremely important. In fact, we think that PQRS should be viewed as the source of potential measures for application under the new quality system. Moreover, we believe that measures should not be used under the quality system for payment update upuropses until physicians have had an opportunity to become familir with them through reporting, much as the Hospital Inpatient Value-Based Purchasing Program does not adopt a measure until measure data have beenr eporte don the Hospital Compare website for a full year.”
Premi’s Childs also urged the committees to explore efficiency measures, especially those developed under the aegis of the National Quality Strategy.