Today, by a vote of 51 to zero, the House Energy and Commerce Committee passed H.R. 2810, the Medicare Patient Access and Quality Improvement Act. This bipartisan legislation to repeal and replace Medicare’s sustainable growth rate (SGR) payment system is sponsored by committee leaders Reps. Michael Burgess, MD (R-TX), Frank Pallone (D-NJ), Fred Upton (R-MI), Henry Waxman (D-CA), Joe Pitts (R-PA), and John Dingell (D-MI ). The AANS and CNS have been actively involved in developing this bill and the current version of the bill reflects many of neurosurgery’s core principles, including:
- Repeals the SGR and includes a 5-year period of stability in Medicare physician payments, with positive updates during the transition period and each year thereafter;
- Encourages physician-led quality improvement that allows the medical specialty societies to determine the most appropriate and clinically relevant quality improvement metrics and strategies for use in future quality initiatives;
- Adopts flexible criteria that allow physician participation and engagement in delivery and payment models that are meaningful to their practices and patient populations, including preserving a viable fee-for-service option and recognizing the value of clinical data registries for improving quality; and
- Establishes legal protections making it clear that the development, recognition, or implementation of any guideline, quality improvement program or other payment standard under Federal healthcare law does not establish a new standard of care in any medical malpractice claim.
The AANS and CNS do have several outstanding concerns, however, which we hope to address as the legislative process continues. These include:
- Payment updates should keep pace with medical practice cost inflation to allow physicians to support their practices, including quality improvement infrastructure such as electronic health records (EHR) and clinical data registry participation;
- Any new quality update incentive program should replace the current Physician Quality Reporting System (PQRS), EHR and Value-Based Payment Modifier (VBPM) programs and penalties;
- It is unnecessary and duplicative to include provisions related to misvalued codes, as the mechanisms in current law adequately address this issue; and
- Patients and physicians should be allowed to privately contract on case-by-case basis, with beneficiaries receiving the Medicare allowable fee.
The House Ways and Means Committee is expected to address SGR legislation sometime in September, and the Senate Finance Committee is also evaluating options for reform. Finding bipartisan budget offsets to pay for the legislation remains a potential sticking point, but momentum for repealing the SGR continues to build and all of us here at Neurosurgery Blog are cautiously optimistic that Congress will finally deal with this challenge once and for all.