Is the SGR Replacement Almost Here?

Kenneth J. Terry, MA

Disclosures

March 14, 2014

In This Article

Medical Societies Want the SGR Repealed

The leading medical societies support the SGR replacement legislation. They back it above all because it would repeal the SGR, which has been threatening the income of most physicians since it was introduced in 1997. Although Congress has enacted a series of "doc fixes" to put off legally required pay cuts since 2003,[4] none of these patches has dissolved the black cloud hanging over the heads of doctors.

With regard to the value-based modifier of Medicare rates -- the centerpiece of the MIPS -- the professional societies part ways. The American Medical Association (AMA) continues to oppose the value-based modifier [personal communication from R.J. Mills of the AMA, quoting AMA President Ardis Dee Hoven, MD], although it has praised the SGR bill's "pathway to new models of healthcare delivery and payment."[5] In contrast, the American Academy of Family Physicians (AAFP) views the bill's emphasis on value-based reimbursement as a step in the right direction.

"It will be good for physicians -- especially our members -- who have led the way in transforming care along the lines of the patient-centered medical home and paying attention to quality improvement," says Reid Blackwelder, MD, President of the AAFP. "Not every practice will find the same success. It's not an easy transition, and some will do it better than others. But this is the challenge. Our members have led the way in electronic records, in meaningful use, and in getting National Committee for Quality Assurance (NCQA)-certified [as medical homes]. The practices that have done that are more likely to benefit."

Molly Cooke of the ACP believes that the value-based reimbursement approach -- whether that takes the form of the MIPS or the APMs -- will benefit not only physicians, but also patients and healthcare. "Trying to align how physicians and hospitals are paid with the benefits they can accomplish for patients is an important shift in how we're doing things," she says.

The SGR replacement bill offers several advantages to doctors, Cooke continues. It simplifies the existing regulations by combining programs; it's more transparent than the current programs in terms of showing doctors what they need to do to earn incentives; and it gives physicians the opportunity to earn much more than they can under existing law.

The downside is that not everyone in the MIPS will benefit. "To a considerable extent, the bonuses for high-performing physicians will come from penalties incurred by people who don't do as well," she points out.

Blackwelder agrees that this is what would happen to MIPS participants. But he hopes that carrots will prevail over sticks before the penalties become severe. "I expect that there will be improvements in paying for value long before 2020. I think we'll find other ways of paying for value, and that will drive practices toward making sure that they meet those guidelines [for quality and efficiency]."

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