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  • Congressional Committee Takes First Steps on Payment Reform

    Addressing the flawed sustainable growth rate (SGR) brings Congress 1 step closer to overhauling the Medicare Part B payment system out of its current fee-for-service model. On July 31, the House Energy and Commerce Committee unanimously passed HR 2810, the Medicare Patient Access and Quality Improvement Act of 2013, to repeal the SGR.

    The committee's first move, in what is expected to be a months' long process, was to pass the specific policy provisions relating to repealing and reforming the SGR. In its current form the bill does not address Medicare "extenders," Medicare therapy cap repeal, or how to pay for the $139 billion cost of the legislation. Congressional indications are that the House and the Senate will begin to discuss these items following the planned congressional August recess. During deliberations of the legislation within the committee, several congressional champions for therapy pushed for inclusion of therapy cap repeal in the final legislation.

    HR 2810 includes 3 phases for payment reform:

    • Phase I repeals the current SGR formula and provides for a period of stable provider payments.
    • Phase II establishes a Quality Update Incentive Program (QUIP) to tie quality measures to payment.
    • Phase III analyzes new payment models to move providers out of the current fee-for-service system.

    With the February announcement from the Congressional Budget Office that the cost to repeal the flawed SGR formula had decreased from $243 to $139 billion, legislators have shown increased interest in repeal and reforming the current Medicare payment system. APTA has worked with the committee and provided feedback based on our SGR priorities as this legislation was being created. APTA continues to advocate for inclusion of a long-term solution to the therapy cap as this moves forward and will keep members informed as proposals move forward through Congress this fall. Members are encouraged to sign up for APTA's advocacy network, PTeam, to show support for APTA's policy priorities in this and other pieces of key legislation.


    • Phase III: If we move away from the fee for service to a fixed fee, this will increase the likelihood of multiple patients being seen at one time. This will ultimate lower our standards of care. The new payment system must take into account patient outcomes. The better the outcome the lower the incident of returning to therapy and better function at home.

      Posted by Paula Webster on 8/2/2013 6:26 PM

    • Hospitals are doing the same thing by employing physicians.

      Posted by Jake on 8/3/2013 1:05 AM

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