At the end of July, before legislators left for the recess, they took a major step forward in the decade long effort to repeal the SGR formula when the House Committee on Energy and Commerce voted 51-0 to support the “Medicare Patient Access and Quality Improvement Act” (H.R. 2810). This bill repeals the SGR and replaces it with annual updates of 0.5 percent. Beginning in 2019, physicians would be able to report data under a new Quality Update Incentive Program (QUIP) and earn up to an additional 1 percent update. Those scoring low on quality measures would potentially face a net cut of 0.5 percent. Under the bill, medicine will play a central role in designing the quality metrics. The bill also creates a pathway for physicians to design and participate in Alternative Payment Models (APMs) under which they would be exempted from the QUIP requirements.
While these are all critical improvements to the current Medicare physician payment system, many issues still remain. Of particular concern are the adequacy of the proposed updates and the potential complexity of the new reporting system. There are provisions in the bill that have the potential to drain resources from the overall physician reimbursement pool.
When they return from recess, two additional committees, the House Ways and Means Committee and the Senate Finance Committee, will work to produce their own versions of the legislation, each with the goal of repealing the SGR, focusing on quality over volume and making alternative payment and delivery models available. Later in the year, these measures will likely be combined and brought to a vote on the House and Senate floors.
The Congressional recess is a time for constituents to meet with lawmakers and discuss legislation. The break is a great opportunity to fill them in on the proposals that have been made in the House Energy and Commerce Committee, and encourage them to support Medicare payment reform.
The AMA offers resources to help contact and schedule meetings with your local representatives and senators. You can contact their Physicians Grassroots Network hotline at 1-800-833-6354. Take advantage of this valuable resource to help repeal the SGR and replace it with a sustainable payment reform model.