Washington Scene: STS Advocacy Spurs Progress on Medicare Physician Payment Bill

STS News, Spring 2014 -- On February 6, H.R. 4015 / S. 2000, "The SGR Repeal and Medicare Provider Payment Modernization Act of 2014," was simultaneously introduced in the US House of Representatives and the US Senate. The bill is the product of an agreement among the three committees of jurisdiction: the House Ways and Means Committee, the House Energy and Commerce Committee, and the Senate Finance Committee. The House subsequently passed a version of the bill with pay-fors that divided Representatives along partisan lines. As of this writing, the Senate was expected to take similar partisan action.

The final policy proposal represents more than a year of collaboration among the committees, highlighted by unprecedented outreach to stakeholders from across the medical community. From the beginning of this process, STS has provided thoughtful and constructive feedback, earning the Society a seat at the negotiating table and recognition as a key ally.

Because of direct advocacy from hundreds of STS members who wrote or called their legislators, visited with members of Congress in Washington or their home district offices, or hosted policymakers at their medical facilities, the Society was instrumental in shaping this legislation that is intended to transform the health care system into one that rewards physicians for the quality health care they provide.

Throughout the drafting process, STS advocated for leveraging the unique power of clinical registries, combined with administrative claims and patient outcomes data, to improve quality and efficiency in the health care system. In numerous public comments to the committees of jurisdiction and Congressional testimony from STS Past President Jeffrey B. Rich, the Society asserted that without a national infrastructure for collecting, aggregating, and evaluating clinical information against valid, risk-adjusted quality measures, any effort toward true payment reform would be difficult, if not impossible.

The bill is bipartisan, bicameral legislation that makes important strides toward developing a data-driven infrastructure through its focus on clinical registries. The proposed bill even allows qualified clinical data registries to access Medicare administrative claims data for the purpose of executing the reforms. STS also supports the following additional provisions in the bill:

• A threshold model of physician performance measurement under a new merit-based incentive payment system that allows all providers to be rewarded for exceptional quality and efficiency, rather than a model that promotes competition and discourages providers from sharing best practices;

• A pathway for the development of specialty-driven alternative payment models that will allow patients and providers alike to benefit from quality and efficiency improvements;

• 5 years of positive payment updates as physicians transition to the new payment models described above; and

• Unambiguous guidelines to promote the application of appropriate use criteria and legal protections for providers who engage in quality improvement efforts.

Although this is the first time that there has been broad consensus throughout the medical community and within Congress about the policies that should replace the flawed sustainable growth rate formula for Medicare physician payment, the Society’s advocacy work is far from complete. Members of Congress must be convinced to do the hard work of coming up with approximately $125 billion to pay for H.R. 4015 / S. 2000, which means that they need to hear from the patients and physicians who will benefit from a reformed payment system.

STS members, along with colleagues from other surgical specialties and the entire field of medicine, are participating in a massive grassroots advocacy campaign. Please visit www.sts.org/advocacy and tell your members of Congress what Medicare physician payment reform will mean to you, your practice, and your patients.