Bipartisan plan calls for SGR repeal, replaced by payment updates, value-based care

January 23, 2015 In The Press0

By Jessica Zigmond

Posted: February 6, 2014 – 3:30 pm ET

“Skate to where the puck is going to be not to where it has been”– Wayne Gretzky

Starting in 2018, payments in the new system would be adjusted based on performance in the new incentive-pay system, referred to as MIPS, which would consolidate three current incentive programs: the Physician Quality Reporting System (PQRS), which provides incentives for physicians to report on the quality of care measures; the Value-Based Payment Modifier, which adjusts payment based on quality use of resources; and meaningful use of electronic health records.

The new MIPS would apply to doctors of medicine or osteopathy, dental surgery or dental medicine, podiatric medicine, chiropractors, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Other professionals who are paid under the physician fee schedule may be included starting in 2020 if viable performance metrics are available then.

Meanwhile, the agreement provides a 5% bonus to providers who receive a significant portion of their revenue from an alternative payment model that includes a quality-measurement component and risk of financial losses or a patient-centered medical home. Participants in the program would have to receive at least 25% of their Medicare revenue through an alternative payment model in 2018-2019, and the threshold would increase over time. The policy also provides incentives for private-payer alternative payment models. And it establishes a technical advisory committee to review and recommend physician-developed alternative payment models based on criteria developed through an open-comment process.