In a twist in the battle over healthcare reform, Republicans largely agree with Obamacare’s goal of replacing the traditional fee-for-service model of how doctors get paid by Medicare to focus more on the quality of care.
But lawmakers complain the administration’s approach has resulted in too much regulation for their taste.
A major part of Obamacare was to shift Medicare payments away from the traditional fee-for-service model, in which a doctor gets reimbursed for every test or service provided. Instead, doctors should get reimbursed based on the quality of care they provide, the administration has argued.
The goal is to avoid unnecessary tests or treatments that can lead to out-of-control healthcare spending.
But Republicans have lashed out at the administration’s heavy regulatory approach.
“The administration’s focus on uprooting and overhauling the delivery of care in this country is concerning,” said Rep. Tom Price, R-Ga., chairman of the House Budget Committee.
Price, a doctor himself, told the Washington Examiner his concern is the various payment models and regulations implemented by the administration to try to incentivize quality. The administration has a goal to shift 30 percent of all fee-for-service payments to quality by this year and 50 percent by 2018.
“This administration’s constant rulemaking and over-regulating continue to further entangle Washington in the delivery of patient care,” he said.
For example, Price and Rep. David Scott, R-Ga., introduced legislation last month to delay implementation of a new way for Medicare to pay for hip and knee replacements.
The Centers for Medicare and Medicaid Services said that the new model ties payments to the quality of the surgery.
Hip and knee replacements are the most common inpatient surgery under Medicare. CMS said the quality of those surgeries varies based on the location, with some hospitals having a high rate of patients returning to the hospital because something went wrong, such as an infection.
The payment model will factor in the hospital readmission rate, specifically whether the patient comes back 90 days after he or she leaves the hospital after surgery.
Price argues that the implementation of the rule, which started April 1, is “unreasonable” because it doesn’t give hospitals enough time to comply.
Other Republicans have criticized a recent decision by the Obama administration to experiment with payments to doctors. The administration wants to lower payments to doctors for more pricey drugs in an effort to curb prescribing of unnecessary treatments.
However, GOP leaders have balked at the experiment.
The proposal “stands to limit access to the critical care the sickest Medicare beneficiaries rely on, as well as disrupt how healthcare providers serve patients in the future,” according to a joint statement from House Ways and Means Committee Chairman Kevin Brady, House Energy and Commerce Committee Chairman Fred Upton, R-Mich., and Sen. Orrin Hatch, chairman of the Senate Finance Committee.
Price released his own Obamacare replacement plan that doesn’t appear to address a shift away from fee-for-service. His bill does require the administration to set up a system for the “development of performance-based quality measures that could be applied to physicians’ services under the Medicare program.”
However, any measures would need to be approved by the Physician Consortium for Performance Improvement, a panel created by the American Medical Association that identifies evidence-based clinical performance measures.
Price’s replacement plan hasn’t moved much in the House as Republicans are trying to gather consensus around a single Obamacare replacement plan. Democrats have consistently criticized House Republicans, who voted to repeal Obamacare more than 70 times, pushing repeal without a replacement.
House leadership set up a committee to reach consensus on an Obamacare replacement plan. Upton, a member of the task force, has said the plan will be ready this summer.
He has said that Republicans don’t plan to vote on the plan, but it would serve as a template for how the chamber would go about repealing Obamacare if a Republican reaches the White House.
Some lawmakers are touting common ground through Medicare Advantage, a program that allows seniors to get a private healthcare plan reimbursed by Medicare.
Medicare Advantage can provide “comprehensive coverage under one plan, rather than rely on the traditional fee-for-service Medicare program,” according to an op-ed in The Hill newspaper co-written by Rep. Tim Walberg, R-Mich.
Medicare Advantage has been the subject of some heated political battles in recent years, however. Obamacare called for cuts to Medicare Advantage payments to bring the program’s costs in line with traditional Medicare.
However, a powerful lobbying push from the insurance industry, with aid from hundreds of lawmakers in Congress, has been able to forestall some of the cuts and other reforms.
Meanwhile, fee-for-service continues to remain the most common method. A recent study published in the journal Health Affairs found that nearly 95 percent of all physician office visits in 2013 were reimbursed through fee-for-service.
