Faced with steep pressure from doctor groups and bipartisan lawmakers, the Obama administration decided to ease doctors into a dramatic overhaul to the way they get paid by Medicare.
The administration released on Friday a final rule governing Medicare payments, implementing a 2015 law that eliminated the much-maligned sustainable growth rate formula. The rule has earned plaudits from doctor groups and lawmakers for giving doctors enhanced flexibility to meet requirements that tie Medicare payments to patient care.
“Last month, the administration provided early word of reporting flexibility for physicians and other health care providers, according to a statement from a bipartisan group of House committee leaders. “We believe that these and other flexibilities, which are included in the final rule, will help ensure that Medicare beneficiaries receive the value-based care they deserve.”
The statement was from Reps. Fred Upton, R-Mich., and Frank Pallone Jr., D-N.J., the chairman and ranking member of the House Energy & Commerce Committee. Reps. Kevin Brady, R-Texas, and Sander Levin, D-Mich., leaders of the House Ways and Means Committee, also signed on to the statement.
The committee leaders wrote to the administration in September to ask for additional flexibility for physicians.
Bipartisan comity isn’t surprising as the 2015 Medicare Access and CHIP Reauthorization Act was the result of major bipartisan agreement. The law permanently nixed the sustainable growth rate formula and ended a series of short-term, annual patches to the formula that forestalled major cuts to doctors’ Medicare payments.
A major doctors group, the American Medical Association, said that it appears the administration was “responsive” to concerns raised by its members.
The administration’s final rule included several new measures to help doctors implement a new payment model that partially links payments to the quality of care provided.
For instance, it increased the threshold for who would be excluded from reporting quality measures to the federal government.
When the rule was issued, it said that doctors who got $10,000 or less in annual Medicare Part B money and less than 100 Medicare patients a year were exempt. Now that threshold increased to $30,000 or 100 or less patients.
The administration also phased in the reporting requirements for doctors.
The rule takes effect in 2017, and a doctor can choose their own path for reporting quality measures.
So a doctor starting on Jan. 1 can either choose to report quality measures for the entire year or for only a 90-day period, and the doctor gets to choose when that period starts and finishes.
“Originally every clinician would have to start reporting on Jan. 1 for the full year and they would be subject to cuts [to payments],” said John Feore, director at the consulting firm Avalere Health.
A doctor who isn’t exempt from reporting quality measures still has to do some reporting. Feore said that if a doctor ignores the reporting requirement altogether then Medicare payments would be cut by 4 percent.
The quality measures vary based on the type of doctor you are. For instance, there are specialty measures for cardiologists or dermatologists that apply to their practice.
“If you are in cardiology or dermatology or an emergency physician you can just report from your set of measures, which will be a lot more relevant to you,” Feore said.
Each doctor will get a performance score based on how they fare on three types of measurements.
About 60 percent of the score is pegged to quality measures, such as whether the doctor assigned the right diagnostic test. Another 25 percent is based on how well the doctor incorporates the use of electronic health records and the remaining 15 percent is linked to care coordination such as sharing information with other practices or hospitals or screening for mental health conditions, Feore said.
He added that while 2017 is considered a transition year, 2018 appears to also be reserved to give doctors more time to incorporate the new payment requirements.
Feore noted that patients aren’t likely to see much, if any, changes at first. However, the end goal is to improve care for patients and improved coordination between doctors and hospitals.
