Several groups that delivered comments expressed concern with a provision in the committees' proposal that would require physicians to seek authorization before ordering services if their practice patterns are inconsistent with their peers'.
The Medical Group Management Association, a trade group that represents 33,000 medical practice administrators and executives, said the quality safeguard could do more harm than good.
“Prior authorization is extremely burdensome on practices, who must expend staff time and money in order to facilitate the prior authorization process,” the MGMA said in a letter to lawmakers. “Waiting for authorization can lead to delays in the delivery of care, sometimes for a week or more, which can be particularly difficult for a Medicare patient.”
Before a physician is labeled an outlier, the MGMA suggested, the CMS should have to investigate the clinician's case mix and other variables that may skew an analysis of the ordering patterns, and there should be an opportunity to appeal the designation.
The American College of Emergency Physicians, meanwhile, added that defining a clinician's peers should be a “self-selection” process and could be based on American Board of Medical Specialties board certification or Council for Medical Specialty Society-designated specialties.
The quality performance analyses, the emergency physicians added, should be risk-adjusted to account for a clinician's case mix and patients' demographic characteristics, insurance status and medical history.
“Otherwise, Congress risks creating a system that denies access to healthcare for the sickest patients and unfairly penalizes safety net providers,” the organization said.
A permanent fix for the hated SGR formula has proved elusive for a decade, but lawmakers and industry groups are expressing hope that it's viable this year because the estimated cost dropped substantially due to slower Medicare cost growth—the 10-year cost is now believed to be $139 billion. The House and Senate committees have not, however, proposed a way to pay for their proposal.
The Federation of American Hospitals warns in its comment letter that paying for the SGR fix with cuts in payments for hospital services would be catastrophic.
“At a time when healthcare spending is experiencing an unprecedented slowdown, enough is enough,” the FAH said in the letter.
Last week, the chairman of the Medicare Payment Advisory Commission suggested the advisory panel break from its tradition of recommending ways to replace the SGR and cover the costs in its March report to Congress.
“The reason is that there is momentum on this issue,” MedPAC Chairman Glenn Hackbarth said, “and the last thing I want to do is disrupt the progress now underway.”
Follow Virgil Dickson on Twitter: @MHvdickson
