Reform Update: Doubt surfaces over SGR fix

SGR repeal fever was catching on Capitol Hill this week, but not everyone is confident that 2014 will bring any permanent change to the problematic way Medicare payments to physicians are set year to year.

Two congressional panels this week advanced legislation to eliminate Medicare's sustainable growth-rate formula and replace it with a payment system that rewards quality over volume. The bills passed through committee on the same day the House of Representatives overwhelmingly approved a budget bill that included a three-month payment fix for physicians. Lawmakers hope that it will buy more time for the three committees of jurisdiction—House Ways and Means, House Energy and Commerce, and Senate Finance—to work out their differences, find a way to pay for it and seal a deal.

But Republicans and Democrats still seem far apart on how to finance the repeal. Joe Antos, a scholar at the right-of-center American Enterprise Institute, said the legislation from the two panels is still vague, and he's not convinced that even the recently lowered $116.5 billion 10-year price tag from the Congressional Budget Office will make it politically possible for lawmakers to finish the job. There was much talk a year ago that the SGR fix was “on sale,” and lawmakers didn't act then, he noted.

Adding to his doubts is the budget deal the Senate is likely to pass next week. SGR repeal “is not going to be part of a budget deal because that's over now,” Antos said. “It's got to stand pretty much on its own. It's hard to see what that would be tied to.”

Antos said one possibility is for Congress to agree on another temporary fix after March 31—if the Senate passes the budget bill, as expected—that extends through the end of 2014. He also suggested a lame-duck Congress might be in the best position to do the job.

“If you really wanted to fix it, make the current Congress deal with it after the election in November,” Antos said. “That would require very high confidence that you've got a bill that could actually pass with little refinement.”

The federal HealthCare.gov enrollment website has had 32 information security incidents, of which 11 are being investigated and 21 turned out to be of no concern, according to a memo that Reps. Henry Waxman (D-Calif.) and Diana DeGette (D-Colo.) (PDF) sent to Democratic members and staff of the House Energy and Commerce Oversight and Investigations Subcommittee. Waxman and DeGette released the memo following a classified briefing with HHS officials about HealthCare.gov this week. “The briefing revealed there have been no successful security attacks on HealthCare.gov,” the memo said.

Two days before the one-year anniversary of the shooting massacre at Sandy Hook Elementary School in Newton, Conn., Rep. Tim Murphy (R-Pa.) introduced the Helping Families in Mental Health Crisis Act to improve the nation's system for addressing mental health and substance abuse issues. A psychologist, Murphy has spent the last year examining what obstacles prevent people from getting the appropriate treatment at the right time. One of the bill's provisions would change Medicaid policy so adults with mental illness would have the same access to short-term, acute care hospitalization as other populations. The National Association of Psychiatric Health Systems supports Murphy's legislation.

The National Quality Forum Board of Directors on Friday endorsed a measure that assesses the total cost of services for Medicare beneficiaries who are hospitalized, including costs incurred prior to, during and after a hospital stay. According to the NQF, the CMS already uses this measure in the agency's Hospital Inpatient Quality Reporting Program and its Hospital Value-based Purchasing Program. The measure didn't receive clear support for endorsement when NQF members voted on the issue in October, so NQF sought more feedback from stakeholders about their concerns before endorsing it. “The Steering Committee recognizes that effectively measuring healthcare costs presents significant methodological challenges,” Dr. David Penson, co-chair of the NQF's cost and resource use steering committee, said in a written statement. “These challenges, however, are not insurmountable, and we are encouraged to see so many stakeholders actively engaged in efforts to understand how measures of cost and quality can be used to build a higher-quality healthcare system.”

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