Bicameral 'Doc Fix' Aims To Permanently Replace SGR November 1, 2013 Health Care Reform, Medicare, News SGR, SGR repeal, sustainable growth rate 0 The Senate Finance Committee and House Ways and Means Committee released a summary of a framework for repealing Medicare’s sustainable growth rate (SGR) formula. The bipartisan draft framework is expected to cost less than a similar House bill (HR 2810) because it would freeze physician payments for 10 years, while HR 2810 would include 0.5% annual updates over five years. Some of the key provisions outlined in the discussion draft include: The SGR formula is repealed. Annual fee schedule payment updates would be frozen for 10 years; annual positive updates would begin in 2024. A new “value-based performance (VBP) payment program” would be used to adjust payments beginning in 2017. This new VBP program essentially combines all the current incentive and penalty programs (e.g., value-based modifier, meaningful use, PQRS) into one budget-neutral program. Payments could be increased or decreased significantly, depending on how well a physician scores relative to others on a composite performance score. Physicians participating in certain alternative payment models, including the patient-centered medical home, would be exempt from the VBP program. Revenue thresholds are established for APMs other than the medical home model, and two-sided risk and a quality component would be required to qualify for a 5% bonus in 2016-2021. Several proposals to “ensure accurate valuation of services” under the physician fee schedule are made. Over a three-year period, misvalued codes would have to be adjusted to achieve 1% in total fee schedule savings to avoid reductions in the total physician payment pool. In addition, the Secretary of HHS would initiate a data collection effort on resource use requiring selected physicians to submit data (CMS may provide some compensation to physician for doing this) or face a one-year, 10% payment reduction. Appropriate use criteria would be applied to certain imaging services; prior authorization requirements would be imposed on outliers. HHS would publish utilization and payment data for physicians on the Physician Compare web site. Comments are closed.
