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CMS Mulling Physician Payment Delay, Shorter Reporting Periods

By Erin Mershon, CQ Roll Call

July 13, 2016 -- Under pressure from lawmakers, the Obama administration may delay the rollout of major changes to the way Medicare pays physicians, which were slated to kick in next year.

Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt, whose agency is overseeing the rollout of the physician payment overhaul (PL 114-10), signaled a willingness to delay the start date for the program at a Senate Finance Committee hearing Wednesday. Lawmakers in both parties expressed concerns in the hearing about how small physician practices will fare under the new rules.

"We remain open to multiple approaches," Slavitt said. "Some of the things that are on the table, that we're considering—they include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them."

Slavitt wasn't specific on how long a delay the agency was considering. Currently, doctors face a potential 4 percent pay cut in 2019 if they perform poorly on the program's quality reporting requirements next year.

Implementing the overhaul—a system designed to replace the much maligned Sustainable Growth Rate formula—is among the Obama administration's biggest remaining health priorities. The changes are designed to transition Medicare away from fee-for-service care and toward paying for quality.

But the program's proposed rules were heavily criticized by doctors in small and solo practices. An Obama administration analysis showed that about 87 percent of those doctors would face Medicare payment reductions under the new program, compared with 18 percent of doctors in practices with more than 100 physicians.

The American Medical Association and several other physician groups have asked the agency to delay the program's launch.

Slavitt also said the agency hopes to make so-called alternative payment models more attractive to physicians—especially those that expect doctors to lower costs and improve quality. But he added that neither physicians nor policymakers should get too caught up with the details of different alternative payment models, but instead focus on the physician and the patient relationships. The models should "work in the background" within that relationship, he said.

"We have to be conscious of the fact that we're putting an awful lot of change into the system and on our physician practices, and too much change on top of an already burdened physician practices is just not where we should be going," Slavitt said. We want "to reduce the burdens at the same time that we're working through these changes."

The agency is also considering changes to the threshold that would keep doctors who only see a few Medicare patients from being subject to the new reporting requirements.

"We're currently looking at that," Slavitt said. "The juice has to be worth the squeeze." 

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