WASHINGTON—The long-awaited sustainable growth-rate fix that passed the House last Thursday and will go to the Senate in mid-April will likely, in addition to instituting a permanent fix for the SGR, simplify quality reporting requirements for providers.
The bill includes a merit-based incentive payment system that would offer bonuses or penalties based on whether physicians score above or below a certain threshold on quality measures, including meeting the requirements for the meaningful use of health information technology.
The new incentive program rolls together three existing quality-incentive programs: the electronic health record incentive program, the Physician Quality Reporting System and the value-based payment system established under the Affordable Care Act. Combining those programs will simplify quality-reporting burdens, said Robert Tennant, senior policy adviser for the Medical Group Management Association.
The new incentives would range from a 4% maximum penalty or bonus in 2019 to a 9% maximum penalty or bonus in 2022 and beyond. The new system would supplant the existing penalties and bonuses under the government's EHR incentive program. Providers now face a 3% penalty starting in 2017, which rises to 5% in 2019 and beyond.
Physicians who receive a significant portion of their revenue from alternative payment models, including from private payers, would be exempt from the new system and would see more generous payment increases from Medicare.
The approach, said Dr. Farzad Mostashari, “is intended to create ongoing incentives for quality improvement, and there are both direct incentives for health IT and health IT as an enabler.”
The new system could play an important role in nudging the industry toward alternative payment models, said Mostashari, a former head of HHS' Office of the National Coordinator for Health IT. The legislation also would reward “timely exchange of clinical information to patients and other providers” and “after-hours access to clinician advice,” a category that could potentially be fulfilled through video visits or secure messaging with doctors.
