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Lawmakers Question How New Medicare Pay Plan May Affect Doctors

By Kerry Young, CQ Roll Call

May 11, 2016 -- Members of a key House panel on Wednesday questioned a top Obama administration official about what steps the Medicare program can take to ease the transition for doctors to a new system of payment, which will tie their reimbursement more closely to quality judgments.

Several members of the House Ways and Means health subcommittee, including Rep. Sam Johnson, R-Texas, questioned at a hearing how doctors in small practices will fare under new Medicare payment rules. The Centers for Medicare and Medicaid Services (CMS) has estimated that it will be hard for doctors, especially those in solo practice, to avoid penalties that kick in in 2019. A Medicare draft rule released last month includes a chart that shows most doctors in solo practices facing reduced pay under the new merit-based incentive payment system, while the majority of those at very large practices would fare better economically.

"We know that there is a burden on us to make reporting as easy as possible," said acting CMS Administrator Andy Slavitt at the hearing, addressing the toughest challenges ahead for doctors in small practices to adapt to the new system.

Rep. Tom Price, R-Ga., asked whether the Centers for Medicare and Medicaid Services could broaden its view on when participation in alternative test programs will allow doctors to be exempted from the new rules. Slavitt said the agency is looking at the experimental programs it now has underway, with an eye toward being generous in these determinations while sticking with the mandates of last year's congressional overhaul of Medicare payments to doctors (PL 114-10).

CMS last month unveiled a detailed draft rule to show how doctors' pay may be raised or docked starting in 2019, depending on how their performance is judged. Another frequent complaint about the draft proposal is how often it proposes to give doctors feedback on their performance. The draft rule "continues the problem of delayed feedback for physicians," said the American Medical Association in a summary of the more than 960-page rule.  

Many health organizations, including Premier Inc., Athenahealth Inc. and several medical societies, asked CMS last year to move toward quarterly feedback reports in designing its merit-based incentive payment system for doctors. However, CMS intends to stick with annual reporting, said analysts at the Brookings Institution in a recent report. Doctors may not have enough time under annual reporting to adjust their practices in order to benefit patients and avoid penalties under the new MIPS rule.

"Quarterly reporting and feedback periods could have made the incentive programs more `actionable' for providers, alerting them to their performance closer to the time the services were rendered and providing more opportunities to improve performance," wrote Brookings researchers Kavita Patel, Paul Ginsburg, and their colleagues in a recent report on the rule.

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