Weigh­ing the op­tions

Re­sults un­clear in plans for doc pay­ment sys­tem

Modern Healthcare - - THE WEEK IN HEALTHCARE - Rich Daly

An over­haul of the Medi­care physi­cian pay­ment sys­tem is again on Congress’ agenda, but it re­mains un­clear as ever whether the lat­est ef­forts will pro­duce any re­sults.

Rep. Allyson Schwartz (D-PA.) caught the at­ten­tion of health­care providers when she in­tro­duced on May 9 the most de­tailed plan to date for scrap­ping the Medi­care sus­tain­able growth-rate for­mula. The fol­low­ing day, the se­nior Se­nate Demo­crat with over­sight pow­ers over Medi­care asked four for­mer Medi­care ad­min­is­tra­tors to pro­duce an over­haul pro­posal within a month.

Both ini­tia­tives drew praise from lead­ing provider ad­vo­cates for high­light­ing the need to re­place the Medi­care physi­cian fee sched­ule, which has re­quired a se­ries of last-minute patches to pre­vent steep cuts in re­cent years. But as the largest physi­cian rate cut ever re­quired by the Medi­care for­mula looms in Jan­uary, the lob­by­ists said nei­ther ef­fort was the break­through needed to fi­nally re­solve the is­sue.

The Schwartz bill would freeze rates at their

“It will not be done, not be­tween now and Dec. 31.” —Rep. Phil Gin­grey (R-GA.)

cur­rent lev­els; pro­vide small in­creases for cer­tain providers for sev­eral years; and di­rect the CMS to de­velop at least four re­place­ment pay­ment op­tions by Oct. 1, 2016. A re­place­ment sys­tem would be­gin in 2018.

That frame­work for grad­u­ally im­ple­ment­ing a care­fully con­sid­ered re­place­ment pay­ment sys­tem drew praise from provider ad­vo­cates.

“Sta­bi­liz­ing physi­cian re­im­burse­ments for sev­eral years while new pay­ment and de­liv­ery mod­els are tested will pro­vide needed cer­tainty for physi­cian prac­tices,” Dr. Wil­liam Zoghbi, pres­i­dent of the Amer­i­can Col­lege of Car­di­ol­ogy, said in a writ­ten state­ment. The Schwartz bill gar­nered ini­tial sup­port from Zoghbi’s group and 14 other provider or­ga­ni­za­tions.

But the leg­is­la­tion also was no­table for the lack of en­dorse­ments—at least ini­tially—from many of the most pow­er­ful provider ad­vo­cates in Washington, such as the Amer­i­can Hospi­tal As­so­ci­a­tion and the Amer­i­can Med­i­cal As­so­ci­a­tion. Of­fi­cials from those or­ga­ni­za­tions did not rule out pos­si­ble fu­ture en­dorse­ments.

One health­care lob­by­ist whose or­ga­ni­za­tion did not back the bill crit­i­cized the sever­ity of the penal­ties it in­cluded for providers who fail to tran­si­tion from a feefor-ser­vice sys­tem to the as-yet un­known re­place­ment sys­tem in fu­ture years.

An­other strike against the mea­sure was that its sup­port from other mem­bers of Congress was limited to first-term Rep. Joe Heck (R-nev.), a physi­cian trained in emer­gency medicine.

Se­nior Repub­li­cans who have taken the lead for their party on the is­sue in the House of Rep­re­sen­ta­tives said they were un­fa­mil­iar with Schwartz’s bill and in­di­cated their fo­cus re­mains on their own ef­forts to repeal the Medi­care physi­cian pay­ment sys­tem.

Rep. Phil Gin­grey (R-GA.), a physi­cian and co-chair­man of the 21-mem­ber GOP Doc­tors Cau­cus, said in an in­ter­view that his group is in dis­cus­sions on an SGR re­place­ment plan with the AARP and Sens. John Bar­rasso (R-wyo.) and Tom Coburn (R-okla.), also physi­cians.

“It will not be done, not be­tween now and Dec. 31,” he said. “It will be in” the next Congress. The group aims to have a deal on re­plac­ing the physi­cian pay­ment sys­tem within 2013.

An­other mark against the Schwartz bill is that the method it uses to off­set the cost of scrap­ping the cur­rent pay­ment sys­tem—count­ing sav­ings from the end of the Iraq War—is staunchly op­posed by mem­bers of over­all Re­pub­li­can lead­er­ship, who view such sav­ings as ap­pli­ca­ble only to deficit re­duc­tion.

The Se­nate ef­fort by Sen. Max Bau­cus (D-mont.), Fi­nance Com­mit­tee chair­man, also has an un­clear fu­ture. He di­rected four for­mer ad­min­is­tra­tors of the CMS and its pre­de­ces­sor agency—gail Wilen­sky, Bruce Vladeck, Thomas Scully and Dr. Mark Mcclel­lan—to de­velop both a short-term and long-term “fix” for Medi­care’s physi­cian pay­ment sys­tem.

Wilen­sky said later in an in­ter­view that she was un­cer­tain whether the four, who worked for both Re­pub­li­can and Demo­cratic pres­i­dents, would find the com­mon ground to pro­vide united rec­om­men­da­tions.

Even if they are suc­cess­ful in that ef­fort, Bau­cus told re­porters he would not com­mit to putting into leg­isla­tive lan­guage ei­ther the for­mer ad­min­is­tra­tors’ rec­om­men­da­tion or his own SGR re­place­ment plan.

Bau­cus said he was un­aware of the Schwartz bill.

Although nei­ther the Bau­cus nor the Schwartz ini­tia­tives may re­sult di­rectly in laws over­turn­ing the physi­cian pay­ment for­mula, provider lob­by­ists said, they could es­tab­lish some of the build­ing blocks for a pos­si­ble deal dur­ing an ex­pected lame duck leg­isla­tive ses­sion af­ter the Novem­ber elec­tion.

Provider ad­vo­cates also said they con­tinue to hope that mas­sive must-pass tax cut ex­ten­sions will sweep up a physi­cian pay­ment over­haul in the dy­ing days of the cur­rent Congress. “Who knows what it will look like,” one said, “but we need this to be part of it.”

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