House SGR reform authors receive physician feedback

Washington Organized medicine is urging members of Congress to adopt meaningful Medicare payment reforms that recognize quality care and improvement activities at the practice level, including the advice written in letters to House lawmakers working on a massive overhaul of the pay system.

House Republicans had released an updated version of a Medicare reform proposal after considering comments on an initial draft earlier this year. GOP leaders on the Ways and Means Committee and the Energy and Commerce Committee included more detail on a physician payment system implemented in three phases, but they also sought more policy ideas from key stakeholders. Lawmakers said they want to accommodate physician practices of all sizes that care for seniors and avoid a one-track, top-down arrangement.

The American Medical Association has kept up an ongoing conversation with House members about eliminating the sustainable growth rate payment formula, which is scheduled to cut Medicare rates by 24.4% in 2014. Congress most likely will prevent and replace the cut as it has done for years, but instead of delaying the next SGR reduction temporarily, both Republicans and Democrats hope it’s replaced permanently with multiple payment models and quality improvements.

“We agree the SGR must be repealed,” the AMA stated in an April 16 letter. “Continuation of this policy impedes the adoption of new payment and delivery modes that are necessary to improve care and slow the growth of costs.”

Lawmakers had asked for feedback about its SGR repeal plan and posed specific questions about quality and alternative pay models. For instance, they sought feedback on how Medicare can address insufficient quality measures for specialties. The AMA stated that officials should give physicians time to develop, test and evaluate such measures. In response to another question about clinical practice improvement, the AMA stated that necessary processes and safeguards are needed to make such activities meaningful not just for physicians, but also for patients.

“Congress should provide the necessary lead time through a scaled approach in rulemaking that establishes criteria for moving toward accurate and meaningful clinical improvement activities,” the AMA said.

The Association stated its strong support for allowing alternative payment models as options in addition to the current fee-for-service model used by most physicians. These would give physicians the ability to select the best models for their practices. At the same time, new models can help patients stay healthy, manage chronic conditions and prevent hospital readmissions after acute episodes.

“The current Medicare payment system can be a major barrier to these kinds of care improvements,” the AMA stated. “It provides no payment for phone calls or emails with patients, to coordinate care among physicians, or for support services to help patients with self-management.”

Organized medicine groups representing specialists also strongly supported the House framework, but they suggested improvements to quality measurement and pay models that rely on resource use. The American College of Cardiology believes physicians should not be rewarded for providing low-quality care merely because it may save the program money. “For that reason, we support measures of efficiency that require meeting a quality threshold before assessing the resource use,” the ACC said in an April 18 letter.

The American Academy of Family Physicians commended House members for moving forward on drafting a reform plan quickly. AAFP noted that most efficiency measures achieve short-term savings to the health system but do not accrue at the practice level.

“Efficiency measures without gain sharing across the health care system are likely to be ineffective,” the academy stated in an April 15 letter. “The AAFP believes that the evidence is clear that the way to achieve savings is to firmly base health care delivery on primary care.”