Many physicians, no doubt, would prefer regular payment updates, not updates based on complex measures of quality and value. The momentum in Washington for continued payment reforms, however, is strong.
The repeal of the SGR is the carrot; the far-reaching payment reforms that the legislation facilitates are the stick. Congress has only allowed such a negative update to happen once in , and over the years has passed 17 short-term patches to override the formula.
The Medicare Access and CHIP Reauthorization Act of HR 2 provides physicians and other health care professionals with stable fee updates for 5 years current levels through June , an update of 0. For to , the current payment system remains unchanged.
In , a new incentive payment program, termed the Merit-Based Incentive Payment System, or MIPS, will replace and consolidate 3 existing incentive payment programs: the Physician Quality Reporting System, the value-based payment modifier, and the meaningful use of electronic health records.
Payments to individual clinicians would be subject to adjustment depending on whether they participated in MIPS or approved alternative payment mechanisms. Alternative payment mechanisms include accountable care organizations ACOs , medical homes, bundled-payment arrangements, and other models being evaluated by the CMS Innovation Center.
Such models involve a risk of financial loss and a quality measurement component. Under MIPS, the payment rates in will be maintained through but with positive and negative adjustments based on the composite performance score of each eligible physician or other health professional on a 0- to point scale.
MIPS will assess performance in 4 categories: quality, resource use, meaningful use of electronic health records, and clinical practice improvement activities. The new incentive payments will be complicated and many of the details remain to be worked out. Under the new legislation, clinicians who receive a substantial portion of their revenues from approved alternative payment mechanisms will not be subject to MIPS. In , the payment rules for all clinicians change again, with payment rates under the alternative payment mechanism increasing by 0.
The legislation protects physicians against malpractice suits by specifying that the quality of care standards in MIPS or other guidelines or standards in Medicare or other federal health programs cannot be used in malpractice or product liability cases. The rule assigns inpatient status and Medicare Part A coverage to all hospital stays of this length or longer, assuming medical necessity supports such a stay.
Stays shorter than 2 midnights are generally considered observation and therefore not covered by Medicare Part A. For example, starting in , premiums for Medicare Part B and Part D would increase for some high-income beneficiaries. The act also requires that electronic health records be interoperable by the end of and prohibits the deliberate blocking of information sharing between electronic health records from different vendors, changes that many clinicians and patients would welcome.
Now that the SGR has been repealed, it is likely that policy conversation about physician payments will move on to other outstanding issues, such as the balance of payments between primary care and other services and continued delivery system reforms, including population-based payments, with no fee-for-service component. Until the details of the measures of quality and value and incentive payments become available, it is uncertain if physicians will consider them reasonable and fair.
At some point, the cumulative effect of the new payment updates will not keep up with physician costs, unless the volume and cost of services substantially decrease, which is the same underlying issue as with the old payment updates. The SGR formula lasted 18 years. Within the decade, its replacement is likely to be under scrutiny as well. Drastic reductions in payments combined with increasing practice costs could make medicine a less attractive career choice for students and force many physicians 55 or older to retire.
This would lead to a devastating shortage of doctors in the U. The Medicare Payment Advisory Commission recommends repealing the SGR formula and including new incentives for individual physicians to control volume growth in the new legislation. Several organized medicine groups spent the latter part of lobbying legislators to permanently repeal the formula.
PYP hopes Congress gets the message and begins moving toward a solution. July December 22, Deal Reached on H. For the best experience, you can use Chrome or Safari.
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