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Rep. Michael Burgess (R-Texas), vice chairman of the House Energy and Commerce Health Subcommittee

Panel airs draft of new doc payment system

By Jessica Zigmond
Posted: May 28, 2013 - 3:30 pm ET

Republican House Energy and Commerce Committee leaders have revealed a draft of a bill (PDF) that would repeal Medicare's contentious physician payment formula and replace it with a payment system that places greater emphasis on quality and efficiency.

Away from Washington this week, panel members announced the latest step in overturning Medicare's sustainable growth-rate formula that began with their framework in February and was revised in April.

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Rep. Michael Burgess (R-Texas), vice chairman of the House Energy and Commerce Health Subcommittee, said in a phone interview that the bill is still very much a work in progress, and that lawmakers have not found a way to pay for it. Burgess sounded excited about the draft legislation, which he said strikes a balance for older physicians who have only known a traditional fee-for-service model and newer doctors who are starting their careers when models such as accountable care organizations and bundled payments are taking off.

“My understanding is after the period of stability, there will be reductions in reimbursement to those in the fee-for-service system, but they can buy back what they lose by hitting those quality metrics,” said Burgess, who said that period of stability is still undetermined, but it would be a certain amount of time in which doctors would know what their Medicare payments would look like—and that they would not be reduced.

The quality metrics that Burgess mentioned are outlined in the section of the draft bill that calls on HHS to establish a “fee schedule provider competency update incentive program,” where HHS' secretary would approve and publish a final quality measure set under which providers would be assessed to determine payment updates. Those quality measures would be developed by medical specialty organizations or other stakeholders, and the secretary would be required to make those measures available publicly.

The bill also would require HHS' secretary to coordinate quality measure sets with other existing measures and requirements, such as the development of CMS' Physician Compare Website, where consumers search for physicians who participate in the Medicare program.

Meanwhile, the legislation would allow physicians to leave the traditional fee-for-service system and adopt payment models that focus on quality and efficiency such as accountable care organizations, medical homes and bundled payments. Under the bill, HHS' secretary would submit biannual progress reports to Congress and the public—through the CMS Website—on the update incentive program.

A committee spokeswoman said in an e-mail that Chairman Fred Upton (R-Mich.) hopes to consider the legislation at the committee level before Congress breaks for its August recess. The panel will host a hearing on Medicare physician payment reform June 5.

“Today's draft legislation is a concrete step forward in establishing an alternative to the SGR and current fee-for-service system,” Anders Gilberg, senior vice president for the MGMA-ACMPE, said in an e-mail. “The language is broad in scope but the draft offers a significant opportunity for physicians to provide feedback to refine a legislative package that can get to floor this year.”

Follow Jessica Zigmond on Twitter: @MHjzigmond

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