Skip to Content


Filter by:



Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

House Committees Release More Details on SGR Repeal and Replace Legislation

April 5, 2013—The House Energy and Commerce and Ways and Means Committees April 3 released a more detailed framework examining how Congress could repeal and replace the Medicare sustainable growth rate (SGR) formula based on feedback provided by stakeholders, including the AAMC [see Washington Highlights, March 1]. According to the committees’ press release, the updated three-phase replacement plan “provides further clarity…to repeal the SGR and reward providers for high quality and efficient care in the fee-for-service (FFS) program, while allowing providers to actively participate in payment and delivery reform.”

Based on stakeholder feedback, the updated proposal includes:

  • Bonuses to physicians for performing “clinical improvement activities,” as an additional means to reward good performance;
  • Processes for determining quality and efficiency measures that focus on evidence while being flexible and specialty-specific, with registries to standardize measures and improve risk-adjustment;
  • Timely performance feedback to providers to improve opportunities to optimize incentive payments; and
  • Risk-adjusting performance on quality and efficiency measures.

Under the bonus payment proposal, providers could receive a variable, performance-based credit in one of three ways:

  • Score on quality measures relative to their peers;

  • Significant improvement in their own quality score from the previous year; or

  • Executing clinical improvement activities.

The updated plan also specified that quality measures are to be risk-adjusted as to the severity of illness so that providers are not penalized for treating sicker or more complicated patients — a point AAMC emphasized in its comment letter to the committees.

The committees’ framework still is not complete. It includes a series of questions to be answered by the provider community by April 15, including:

  • How should the Secretary of Health and Human Services address specialties that have not established sufficient quality measures;

  • Should payments be based only on efficiency for providers that meet a minimum quality threshold; and

  • How long will it take to devise a way to determine efficient use of health care resources?

Contact:

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

.

envelope on a green background

Subscribe to Washington Highlights

RSS icon

Subscribe to RSS

Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


Past Issues


For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org