May 2015 – SGR Appeal

As you are all aware, President Obama signed into law, the bill repealing the SGR.

Much of organized medicine is applauding the repeal as well as defending the new payment system in its place. While there is a 0.5% rate hike each year through 2019, CMS Actuary Paul Spitalnic said on April 9 that these increases will not keep pace with the growth in practice expenses. The bill called the Medicare Access and CHIP Reauthorization Act (MACRA) has pay for performance programs that begin in 2019 allowing physicians to earn bonuses and lump sum payments for the healthcare of patients. This pay for performance money runs out after 2024 so there needs to be alternative payment models developed. MACRA appears to have combined three sometimes overlapping Medicare incentive programs. EHR meaningful use, quality reporting, and the value based payment modifier.

The new incentive program is entitled MIPS (Merit Based Incentive Payment System). We hear and read the word “value” and the question comes to mind as to what is value and who assigns this value. Certainly, patients will be an important part of the equation as they assess their health and determine what they can do to live longer, healthier, more fulfilled lives. This includes, but is not limited to, taking medicines as prescribed, following physician and caregiver orders for treatment, testing, or therapy, keeping followup appointments, getting regular preventative exams and tests, eating well, minimizing deleterious activities, and exercising regularly. It will take all stakeholders to be actively engaged as we effectively change healthcare.

Thanks for reading.

Peter Sneed MD

President Northern Michigan Health Network

NPO Board Member

 

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