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Medicare Official Defends Limits on Doctor Pay Exemptions

By Kerry Young, CQ Roll Call 

May 3, 2016 -- A top Medicare official said his agency's draft plan for new reimbursement rules for doctors fulfills the direction Congress set last year. But he anticipates strong protests from trade groups that wish to see more physicians qualify for exemptions from requirements in the new system.

"We think our proposal is consistent with the law and congressional direction," Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid Services (CMS), said at an American Hospital Association meeting on Tuesday, adding that he expects to receive suggestions from industry executives. "I am sure we will get feedback from our colleagues on the Hill as well, and we welcome it."

CMS last week unveiled its draft plan for changing how Medicare pays doctors, fulfilling a mandate in last year's congressional overhaul (PL 114-10). Most physicians are expected to be switched to the new system, known as the merit-based incentive payment system. Doctors in that system must meet a series of quality measures that could raise or cut their Medicare reimbursements by 4 percent in 2019.

The American Medical Association and other doctors' groups are working now to both help CMS shape the rules and prepare their members for the challenges ahead. 

Doctors participating in other CMS test programs that already put some Medicare reimbursement at risk can be exempted from the merit-based requirements under the draft plan. The exempt doctors can win bonus payments and do not have to comply with all of the rules of the new system if they are already meeting agency standards under other programs.

The qualifying programs include the Next Generation Accountable Care Organization (ACO) model and certain tests of care provided to people who have cancer or failing kidneys. The National Association of ACOs, an industry trade group, already has pushed for broader exemptions, saying that CMS only proposes "a very limited number" of alternative payment models.

CMS is seeking comments through June 27 on the proposal.

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