House Republicans focused on SGR fix

With a House panel discussing physician payment reforms on Wednesday, healthcare providers and industry groups remain hopeful that 2013 will be the year lawmakers repeal the troublesome formula the CMS uses to reimburse Medicare-participating doctors.

Momentum has been building in the lower chamber this year to overturn Medicare's sustainable growth-rate formula. The Republican majority staffs of the House Energy and Commerce and Ways and Committees jointly released a framework that would serve as the foundation to repeal the SGR.

In April, the committees added details to that blueprint and sought feedback from the provider community. And last week, GOP leaders on the Energy and Commerce Committee unveiled draft legislation that will be the focus of Wednesday's hearing. Energy and Commerce leaders released that draft bill without their Ways and Means counterparts, which raised concerns that the two panels were no longer working together on the issue or had hit a stumbling block.

Not so, according to a senior GOP aide for the Energy and Commerce Committee, who said the committees continue to work well together, and that Energy and Commerce took the lead on releasing the draft bill because it is the committee of jurisdiction in this area. That sentiment of collaboration was echoed by Sarah Swinehart, a spokeswoman for the Ways and Means majority staff.

“There was no policy difference,” Swinehart said, adding that Ways and Means would learn from experts at Wednesday's hearing and re-engage with Energy and Commerce to produce a permanent fix to the SGR.

The committee is examining a draft bill, which includes three phases: a period of payment stability and development of an improved fee-for-service program; applying quality measurement to payments; and a Medicare fee-for-service “opt out,” which allows providers to opt out of the modified fee-for-service program at any time in the first two phases to move to an alternative payment model, such as an accountable care organization or a patient-centered medical home.

Rep. Allyson Schwartz (D-Pa.)—who filed her paperwork last month to run for governor in 2014—has introduced her own legislation to repeal the SGR. On Tuesday, Schwartz criticized what she called the “concept paper” that House GOP leaders on Energy and Commerce released last week.

“It is disappointing because while it recognizes and uses the terminology about moving away from fee for service towards a system that rewards quality over volume, it really doesn't do that,” Schwartz said. “It actually takes fee-for-service, maintains fee-for-service as the norm, and slightly modifies it.”

Schwartz emphasized that her bill is farther along in the process, a point echoed by Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association. The group backs elements in the Pennsylvania Democrat's bill that provide a period of stability, which is attractive to providers. But it also has an element that Gilberg thinks could be a sticking point down the road.

“There are differential payments for primary-care physicians, so there is some incentive to show preference for primary care, which has the potential cause for polarization in terms of support,” Gilberg said.

Schwartz's legislation would provide a 2.5% annual increase between 2015 and 2018 for primary care, preventive, and care coordination services by clinicians for whom 60% of their Medicare charges are those services. Meanwhile, all other physicians services would see a .5% increase each year for four years.

Neither Schwartz's legislation nor the draft bill from the Energy and Commerce Committee include how to pay for repealing the SGR, which the Congressional Budget Office now estimates will cost about $139 billion over the next decade, down considerably from previous estimates. The Energy and Commerce aide said the panel will include a way to pay for the fix in its legislation.

The lower price tag on an SGR repeal makes it more attractive to act now, according to Dr. Jeffrey Rich, director at large of the Virginia Cardiac Surgery Quality Initiative and immediate past president of the Society of Thoracic Surgeons. “Now seems like a critical time with sequestration and economic pressures for everything the government pays for,” he said.

On Monday, House Energy and Commerce Chairman Fred Upton (R-Mich.) told Modern Healthcare that he still plans for his panel to consider legislation to repeal the SGR before Congress breaks for the August recess.

Follow Jessica Zigmond on Twitter: @MHjzigmond