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H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013, is the latest legislative proposal to permanently repeal the sustainable growth rate (SGR) provision, a formulaic approach intended to restrain the growth of Medicare spending on physician services. Physician-turned-congressman Rep. Michael C. Burgess (R–Texas) introduced the bill to the House of Representatives in July.
The Congressional Budget Office (CBO) recently estimated that the cost of H.R. 2810, a permanent SGR repeal or “doc fix,” would be $175.5 billion over 2014-23, up from the CBO’s estimates of $139.1 billion in May and $138 billion in February for freezing (i.e., holding flat) all Medicare physician rates for 10 years.
H.R. 2810 differs from other SGR reform proposals. Like all other SGR reform bills, H.R. 2810 would avoid an estimated 24 percent reduction to Medicare physician payment rates that is slated to take effect Jan. 1, 2014, but the bill would also raise payment rates by 0.5 percent per year from 2014 through 2018. That change would increase federal spending by $63.5 billion through 2018, relative to the spending projection under the SGR.
In addition, starting in 2019, H.R. 2810 would either set Medicare payment rates for physician services based on a physician’s performance in the Quality Update Incentive Program (QUIP) or possibly provide for physicians to be paid for some or all of their Medicare services under an alternative payment model (APM). There will be a number of APMs, which are yet to be determined, but they will almost assuredly include accountable care organizations. Making certain assumptions about physician participation in QUIP versus APM, the CBO projects that these two mechanisms will increase federal spending by approximately $112 billion versus current law for 2019-2023.
Unfortunately, like every SGR reform proposal introduced during the past three years, H.R. 2810 does not specify a legitimate source of funding to cover the increased government spending that would result.
Thus, in large measure, to borrow a phrase from the English rock band Led Zeppelin, the SGR reform song remains the same: a high price tag with no one to pay the bill.
Ken Perez is the author of The Sustainable Growth Rate: The Elephant in the Room of Deficit Reduction and a healthcare IT and policy consultant in Menlo Park, Calif.
Publication Date: Friday, September 20, 2013
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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