'Doc fix' advances to full House

The House Energy and Commerce Committee has approved unanimously legislation to repeal and replace the sustainable growth rate (SGR) formula, moving another step closer to a more stable Medicare physician payment system based on delivering quality and efficient care instead of 11th-hour fixes.

The bill moves to consideration by the full House of Representatives. Meanwhile, Congress adjourns today for its month-long recess and won’t be back to work until Sept. 6.  

[See also: Latest 'doc fix' moving forward]

The committee voted 51-0 Wednesday to advance the Medicare Patient Access and Quality Improvement Act, H.R. 2810, but it still does not contain a funding method. Rep. Fred Upton (R-Mich.), committee chairman, said in a statement that the bipartisan supporters “…are all resolved to achieve reform in a fiscally responsible manner.”

Congress has repeatedly prevented Medicare reimbursement rate cuts under SGR from taking effect with a temporary “doc fix.” But there is no certainty that this legislation might become law in time to avert a 25 percent cut in physician payments that will drop in January when the latest band aid expires.

The Medical Group Management Association (MGMA) was encouraged that legislation has begun to work its way through Congress earlier this year than in previous attempts. "Pay-fors have not yet been discussed, and that remains the largest political hurdle," said Anders Gilberg, MGMA senior vice president for Government Affairs, in emailed comments.

He noted that the bill's quality provisions are complex, however. "We are concerned about adding administrative complexity instead of focusing on harmonizing existing Medicare physician quality reporting requirements into a single integrated patient-centered approach," he said.

The 72-page bill preserves an enhanced fee-for-service, repeals the SGR and provides for a period of payment transition. The new system would roll out in phases. First, Medicare would increase payments 0.5 percent annually from 2014 through 2018 as providers transition to reporting of quality measures.

[See also: Another crack at SGR]

In 2019, physicians practicing in fee-for-service would receive an additional 1 percent bonus based on performing quality measures and clinical practice improvements through an updated incentive program (UIP). The payments of low performing physicians would be decreased 1 percent.
Providers may leave the fee-for-service system and opt instead for alternative payment models, including patient-centered medical home, accountable care models, bundled payments for episodes of care, or a transparent process toward another model.

The Congressional Budget Office has estimated the cost of repealing the SGR at about $138 billion over 10 years. H.R. 2810 provides for $100 million being used from the Medicare Federal Supplementary Medical Insurance Trust Fund to help pay for the infrastructure needed and $1 million annually toward provider incentives.

The Bipartisan Policy Center said that not only was the committee developing a long-term payment system but using it to improve quality, value and care coordination in Medicare. However, Katherine Hayes, the center’s director of health policy, said in a statement that lawmakers need to continue their bipartisanship as the bill moves to the House floor, “particularly as potentially contentious policies are added to offset the costs of the bill.”

Full house photo from Shutterstock.com.