The physician community might want to pay attention to what is going on with the sustainable growth rate (SGR).<\/p>\n
Congress is finally on the verge of abolishing the SGR and, in an odd twist, it may not call for a joyous celebration. The crux of the disagreement centers on proposals in the House and Senate which would replace the SGR with pay-for-performance programs linking physician payments to quality. The most controversial aspect of these proposals lies in the Senate\u2019s SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013. Specifically, the plan would introduce a Value-Based Performance Incentive Program (VBP) starting in 2017 for fee-for-service (FFS) providers. The VBP would consolidate the Physician Quality Reporting System, Value-Based Modifier, and EHR Meaningful Use Program into a weighted, composite score. It would also include a new measure of physician engagement in \u201cclinical practice improvement activities\u201d [PDF<\/a>].<\/p>\n However, what makes the VBP especially provocative is that it depends on a budget-neutral payment pool. In other words, there will be clear \u201cwinners\u201d and \u201closers\u201d with penalties for poor performers used to increase payments for high performers. While I laud Congress for seriously attempting to repeal the SGR, ensuring that the new proposal remains budget neutral seems unfair. If the real purpose of this program is to advance the quality of care, then providers should not be penalized for improving at slower rates than their peers. Even if every single provider in the country upgraded the quality of care they deliver, many would still be penalized.<\/p>\n The use of VBP as a carrot and stick is magnified by the fact that it will not apply to providers participating in \u201calternative payment models\u201d (APMs). Clearly, Congress is encouraging providers to shift away from FFS by allowing them to eschew the potential penalties inherent in VBP. This should come as no surprise since the number of APMs has dramatically expanded with the enactment of the Affordable Care Act; an increasing number of providers are participating in accountable care organizations, bundled payment programs, and other pilot projects. Unlike the budget-neutral aspect of the VBP, I fully support Congress\u2019 desire to transition away from the outdated FFS model. APMs, like the one employed by the California Public Employees\u2019 Retirement System<\/a>, have shown that they can drastically reduce the costs of care while maintaining or improving quality.<\/p>\n While I cheer on Congress\u2019 attempt to repeal the SGR and transition the health system towards one that rewards providers based on quality and not quantity, I fear that they may be more concerned with curbing rising health care costs than improving quality. Akin to their approach in the Hospital Readmissions Reduction Program (HRRP), a large number of providers will be penalized despite improving performance. Instead of creating a budget-neutral payment policy, Congress should enact benchmarks for improvement so that providers have achievable targets to aim for. MedPAC has called for similar reforms and this would still allow Congress to recoup payment from providers who fail to reach the preset benchmarks [PDF<\/a>].<\/p>\n I am interested in hearing what the CardioExchange community thinks.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" The physician community might want to pay attention to what is going on with the sustainable growth rate (SGR). Congress is finally on the verge of abolishing the SGR and, in an odd twist, it may not call for a joyous celebration. The crux of the disagreement centers on proposals in the House and Senate […]<\/p>\n","protected":false},"author":889,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[2112,2111,2110,2109],"class_list":["post-40801","post","type-post","status-publish","format-standard","hentry","category-general","tag-aca","tag-budget","tag-congress","tag-sgr"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/40801","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/889"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=40801"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/40801\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=40801"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=40801"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=40801"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}