By Kerry Young, CQ Roll Call
March 10, 2016 -- Congress is unlikely to step in to ease the challenges facing doctors in the years ahead due to the implementation of last year's overhaul of Medicare's payments to physicians, a consultant said at a conference for insurers.
The overhaul (PL 114-10) is intended to spur doctors to embrace new payment systems such as accountable care organizations, which are pegged to judgments about the quality of the care they provide. Those who don't agree to participate in these newer payment models will see the current Medicare fee-for-service system of payments replaced by one that will place more of an emphasis on meeting quality judgments.
Congress in the past has changed many laws and delayed the implementation of regulations at the behest of doctors, such as holding off for several years on a switch to the new ICD-10 billing codes and staving off slated Medicare payment cuts through a series of what were known as "doc fix" bills. That won't be the case for the physician fee overhaul, said Anne Phelps, principal of the health care regulatory practice at consulting firm Deloitte & Touche LLP.
Lawmakers in both parties agree that Medicare needs to readjust its standards for paying doctors, said Phelps, who earlier worked for the Senate Health, Education, Labor and Pensions Committee and as a George W. Bush administration health adviser. The passage of the overhaul last year marked a point of unity for Democrats and Republicans, who were at odds on health policy since the 2010 passage of the health care law, Phelps said at the annual policy conference of America's Health Insurance Plans, a trade group.
"They want to see this work well, both sides," Phelps said. "This is not the ACA."
The Centers for Medicare and Medicaid Services likely will ease the transition in some cases, seeking to make it easier for doctors to meet the standards, but is not expected to delay or undercut the requirements, Phelp said.
CMS is in the process of implementing the first stage of the overhaul, working out the details of the so-called merit-based incentive payment system. Under the law, doctors who after 2019 fare well on quality measures set in initial rules will face rising expectations as new metrics are added as conditions of Medicare payment.
The implementation of the 2015 physician fee overhaul will represent a continual challenge for doctors in the years ahead, she said.
Doctors remain an influential lobbying force in Washington, due to both the clout of the American Medical Association and their presence in virtually all congressional districts. The forces demanding a reshaping of Medicare's payments, though, mean that they will have to adjust to the new reality of this law. The aging of the baby boomers added urgency to steps expected to rein in Medicare's rising costs, whether through immediate pay reductions or through efforts to prevent disease and preserve health such as the quality measures.