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Doctors Not Happy with Medical Home Change in SGR Overhaul

By John Reichard, CQ HealthBeat Editor

August 1, 2013 -- While doctor groups praised the House Energy and Commerce Committee's approval of a Medicare physician payment overhaul bill, they did express concern about some provisions, including one that does not require medical homes to have physicians.

Under the language adopted by the panel, nurse practitioners and physician assistants could set up medical homes, the term that describes a practice that agrees to monitor and quarterback the overall care of beneficiaries with chronic illnesses.

Julius Hobson, a lobbyist with the Polsinelli law firm, said that "there's a some longstanding friction between some of the physicians and the non-MD folks. The non-MD folks think they do a good bit of the work that primary care doctors do" and should be paid accordingly.

"I would anticipate," Hobson said, that physicians would try to get the language struck. But he also noted that there was bipartisan support for including nurse practitioners and physician assistants.

Rep. Lois Capps, D-Calif., who was trained as a nurse and is an outspoken advocate for the profession, is among the proponents of the provision.

Reid Blackwell, president-elect of the American Academy of Family Physicians, said medical homes should be led by physicians. His organizations favors team-based care, and every member of the team is important including nurse practitioners and physician assistants. But physicians, and primary care physicians in particular, are best trained to coordinate complex care, he said.

The American Medical Association (AMA) also had problems with the committee-approved measure (HR 2810). In a letter to committee leaders, the medical group expressed concern about new reporting requirements for physician practices. "Equally important, the policy under current law relating to budget neutrality for misvalued codes must be retained to provide adequate funding of the physician payment pool," the AMA said.

Under current law, when payment-related codes are reviewed and found to have resulted in payments that are too high for a particular type of doctor care, the excess amount goes back into the overall pool of payments so that it does not shrink. However, the Energy and Commerce bill directs the Centers for Medicare and Medicaid Services (CMS) in 2016, 2017, and 2018 to make net payment reductions of up to 1 percent for misvalued services in the Medicare physician fee schedule. The reductions would represent a cut in Medicare spending.

But in a July 25 letter to committee leaders from nine physician groups including the AMA and the American Academy of Family Physicians, the doctors said "from 2001 to 2013, the average annual Medicare physician payment update has been just 0.29 percent. As a result, average inflation-adjusted Medicare payment rates have fallen by nearly 20 percent.

"Siphoning funds from the fee schedule at this time contradicts our shared goal of encouraging physicians to invest in practice changes and prepare for participating in new health care delivery and payment models," the letter said.

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