Monday Musings

On Tuesday April 14th, the Senate voted overwhelmingly to permanently repeal Medicare’s sustainable growth-rate (SGR) formula for physician payment. The SGR would have required a staggering and obviously untenable 21% cut in Medicare physician payments to take effect on April 1, 2015. For over a decade we had an annual crisis of uncertainty over the SGR mandated payment cuts. Each year Congress has postponed steep cuts to physician reimbursement for Medicare providers, creating an ever-widening chasm between the money paid to providers and the Medicare trust fund. How did Congress finally get this gorilla off the back of Medicare providers and end the debate over the “Doc Fix”? In the new legislation passed last month, eligible professionals will receive an increase of 0.5% each year from 2015 through 2019. Then, in 2019, an improved incentive payment program will focus the fee-for-service system on providing “value and quality”. This incentive payment program, referred to as the Merit-Based Incentive Payment System (MIPS), streamlines and consolidates three current incentive programs:

  1. The Physician Quality Reporting System (PQRS) that incentivizes professionals to report quality of care measures
  2. The Value-Based Modifier (VBM) that adjusts payment based on quality and resource use
  3. Meaningful use of EHRs (EHR MU) that entails meeting certain requirements in the use of certified EHR systems.

MIPS also provides financial incentives for professionals to participate in tests of alternative payment models (APMs). Next week I’ll discuss how MIPS will assess the performance of eligible providers (EPs) and – you guessed it—it will have to do with quality measures.