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Details Emerge on 'Doc Fix' Draft, but Three-Month Patch Still Likely

By Emily Ethridge, CQ Roll Call

December 5, 2013 -- Lawmakers on House and Senate committees have made a number of changes to their joint, bipartisan proposal to replace how Medicare pays physicians, in hopes of having dual markups on the legislation next week.

The alterations to the draft legislative framework reflect comments from provider and patient groups, as well as other stakeholders. The Senate Finance Committee is slated to mark up the proposal Dec. 12, and the House Ways and Means Committee may also hold its own markup next week.

"The Committee has made real progress on a bipartisan and bicameral bill," said House Ways and Means Committee Chairman Dave Camp, R-Mich., in a statement. "If that progress continues, I expect the Committee to consider the legislation before the end of next week."

Stakeholders say they are mostly pleased with the changes. But with time running short before the end of the year, lawmakers are also looking at passing a short-term payment patch, most likely for three months, to buy more time for the replacement bill.

If Congress doesn't act, physicians will see their Medicare reimbursement rates cut by about 24 percent after Dec. 31. House Majority Leader Eric Cantor, R-Va., said last week it was possible that legislation related to Medicare physician payments could be on the House floor next week, though he was not specific about what it might be. The House is scheduled to be in recess after Dec. 13.

Rep. Michael C. Burgess, R-Texas, said the scheduling of the Senate Finance markup so close to recess "sort of guarantees" that lawmakers must to do something in the short term to avoid the cuts.

"I don't like it, but I don't want to see doctors have their rates slashed or their checks held," he said. "The bottom line is that we've got to protect the people that are taking care of our seniors."

But several stakeholders warned that the patch should not be too long, so as not to lose momentum behind the replacement.

Burgess said he would push to bring a replacement bill to the House floor within that three-month patch period. "I've had some encouragement about that, not at lot, but I have had some encouragement that that is possible," he said.

He also noted that the GOP Doctors Caucus, of which he is a member, is working on a payment proposal that would incorporate elements of the different committee bills, including his bill (HR 2810) that the Energy and Commerce Committee approved in July.

"Obviously my personal bias is it should hew very closely to the Energy and Commerce product," he said.

As for the dual committee proposal, aides to the Senate Finance Committee and House Ways and Means Committee briefed provider groups on the updates to the draft measure on Wednesday night. The framework would repeal Medicare's current payment formula, and allow physicians to either stay in Medicare's traditional fee-for-service system or move to alternative payment models.

Physicians who remain in the fee-for-service program would have their payment rates frozen for 10 years, but would be able to receive bonus payments through a new, combined, value-based purchasing program.

One of the changes made to the draft framework addresses a physician group concern that that program would force providers to compete against each other to get those bonus payments, rather than sharing best practices.

Under the revised version, instead of simply being rated on whether they achieved certain scores, physicians will also get credit for improving from one year to the next in quality and use of resources.

The updated framework also gives physicians more time to adjust to the value-based purchasing program, and ties less payment to performance for the initial years than under current law. It also allows nurse practitioners, physician assistants, clinical nurse specialists and certified registered nurse anesthetists to participate in the program starting in 2017, up from 2018.

The new framework would make all small practices of 10 or fewer physicians eligible for additional funding to help them move to alternative payment models or the value-based purchasing program. Previously, the funding was available only for practices in rural areas or in areas with a physician shortage. Those groups would still be prioritized under the updated version.

The lawmakers removed a 10 percent penalty on physicians who do not report data to a project to find misvalued Medicare codes, but kept the incentive payments for reporting.

For the alterative payment models, the updated draft would provide a "cushion" for physicians who want to participate in new models but do not quite reach the required amount of revenue received from Medicare patients each year.

The new "partial qualifying APM participant" category would apply to physicians who come close to qualifying for that year's revenue threshold. Those providers could choose to instead participate in the value-based purchasing program and get a bonus, or choose not to and receive no payment adjustment.

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