SGR, Medicare Reimbursement Could See Changes

A bicameral effort is quickly gaining traction in an effort that would forever change the sustainable growth rate (SGR) and Medicare reimbursement model.

A “bicameral effort” is quickly gaining traction in an effort that would forever change the sustainable growth rate (SGR) and Medicare reimbursement model. The House Ways and Means and Senate Finance committees drafted a discussion that analyzes how the administration might best shift from fee-for-service care models to ones that are value-based. Some of the strategies toward realization of this goal include the freezing of reimbursement rates and permanent repeal of the SGR, integration of meaningful use incentives into other existing programs, 5% reimbursement bonus payments for savings obtained through non-traditional models under a new Alternative Payment Model (APM) structure, and expansion of the permitted uses by Qualified Entities (QEs) of Medicare paid claims data.

Achieving this change would require participation from stakeholders across the entire spectrum of the healthcare industry. Dan Haley, vice president of government and regulatory affairs at Athenahealth, offered 3 suggestions for this successful transition.

The first is to structure APMs with enough flexibility that independent providers could participate. Other care models currently restrict private practitioners from achieving value, due to their often limited ability to reach quality benchmarks. APM models, he argues, could enhance care coordination. Mr Haley also suggests that the integration of meaningful use into healthcare practices subsidized by the government, and that for-profit organizations should be able to qualify for QE status in order to expand Medicare paid claims data consumption.

“The bottom line is that with the right modifications, the SGR bill could make a meaningful difference in Medicare reimbursement, ensuring that all doctors are treated fairly, paid for their services, and able to seamlessly share valuable patient information. We still have a ways to go, but we are closer than ever to finding solutions to help health care work as it should,” says Mr Haley. “The bipartisan SGR proposal is the first step. With a few minor enhancements it could lead to a bill that will make meaningful, lasting reforms to Medicare and health IT policy alike.”

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3 Humble Suggestions for SGR and Meaningful Use [Government Health IT]