Physician Groups Offer Recommendations to House Committee on SGR

Late last week, medical societies submitted their advice to House Ways and Means Committee Republicans in an effort to repeal the Sustainable Growth Rate (SGR) formula and stabilize payments for physicians while CMS tests replacement plans. Last month, the House Ways and Means Committee sent 70 medical groups a request asking for their input to replace the current physician payment system.

Medical groups, like the American Medical Association, informed Committee members that there are many approaches that providers could take simultaneously, and they should be allowed to choose which ones work best for them.  AMA’s letter also stated that providers should be given sufficient time and support to transition to the new approaches and Congress could set milestones to measure progress.

Other key recommendations made to the Committee included:

  • reducing the regulatory burden on physicians;
  • provide flexible waivers for fraud-fighting measures for physicians leading certain delivery models including the Ethics in Patient Referrals Act (or “Stark law”), the federal anti-kickback statute, the civil monetary penalties law prohibiting hospital payments to physicians to reduce or limit services (gain-sharing CMP), and the CMP prohibiting beneficiary inducements;
  • ensuring that antitrust laws and enforcement are not barriers to physician-led models;
  • eliminating the silos between Part A and Part B;
  • changing regulations on electronic prescribing and health records; and
  • eliminating retroactive cuts for penalties under the electronic prescribing (e-prescribing) program, physician quality reporting system (PQRS) and electronic health record (EHR), or meaningful use, incentive program.

At this time it’s unclear whether or how the Committee will use this information to introduce specific legislation to address the SGR before it expires early next year. The Senate Finance Committee asked a panel of former CMS Administrators similar questions at a roundtable hearing earlier this month, signaling that both chambers have made the SGR a high priority.

MedPAC Appoints New Members to Commission

Last Thursday, the Government Accountability Office announced the appointment of five new members to the Medicare Payment Advisory Commission (MedPAC) and reappointed current MedPAC Chair Glenn Hackbarth to another three-year term. The newly-appointed members are: Alice Coombs, a critical care specialist and anesthesiologist at South Shore Hospital in Weymouth, MA; Jack Hoadley, a research professor at the Georgetown University Health Policy Institute; David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit; Rita Redberg, a professor of clinical medicine at the University of California at San Francisco Medical Center; and Craig Samitt, president and CEO of the Dean Health System in Madison, WI. Their terms expire in April 2015.

Senate Committee Holds Hearing on Innovation

On May 23, the Senate Finance Committee held a hearing titled “Progress in Health Care Delivery: Innovations from the Field,” to solicit feedback from health care groups about the ways the private-sector has worked to drive down medical costs while enhancing patient outcomes and quality of care.

Witnesses at the hearing specified that a critical piece to improving the health care system is increasing physician involvement through patients’ entire episode of care. Paul Diaz, J.D., President and Chief Executive Officer, Kindred Healthcare, Inc., Louisville, KY, told the committee that “under the current fragmented system, physicians typically oversee patient care within settings, but rarely follow patients from acute, to post-acute, to home to make sure that care is coordinated and seamless across settings.”

Panelists also noted that health IT can help ensure care is better coordinated between sites, and they called on lawmakers to provide more financial support to providers to help them implement electronic medical records and other IT systems. Panelists said that while pilot programs that emphasis information sharing at their respective organizations were showing positive signs, they are very costly and adoption of automated information with health care is still lagging behind other sectors in the economy.

To access a recording of this hearing, click here.