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U.S. Congress Announces Plan to Fix SGR System


IP Blog | Dave Melin | February 9, 2014

BioBlogWeeklyThis week in heathcare, the U.S. Congress unveils a bipartisan plan to reform the Sustainable Growth Rate (SGR) reimbursement model. This proposed physician payment plan may ultimately lead to substantial changes in Medicare reimbursement.

Hill Plan Would Reward Medicare Doctors For Quality

On Thursday, a bipartisan group of committee leaders in both the House and Senate announced that they had reached a deal on a plan to transition reimbursement to focus more on quality of care and less on fee-for-service. Notably, the plan proposes to give doctors a 0.5% payment increase over the next five years as this plan is phased in and incorporate physician-developed clinical care guidelines to ensure care is appropriate and cost-effective.

Repealing and Replacing the Sustainable Growth Rate [summary from Congress]

The House Energy and Commerce Committee offered a brief summary of the proposal on their website, where they argued that the plan helps to avoid “draconian cuts” and “repeals the SGR and transitions Medicare away from a volume-based system towards one based on value.”

Congress Reaches SGR Deal on Policy; Last Hurdle Is Paying for It

In a statement on their website, COA (Community Oncology Alliance) said of the plan, “We are especially pleased about the favorable treatment of the medical home and advanced payment models,” but also acknowledged, “There are provisions that we need to look closer at, especially those dealing with advanced imaging.” They also noted that while a plan for reform has been proposed, it is not yet certain how Congress plans to pay for it.

SGR Fix: No Pay Cut!

While many are glad to see Congress finally addressing the issue of SGR reform, health policy professor David Emory, PhD, worries that the additional micromanagement by the U.S. Government could lead to “politicization of decisions about what constitutes quality care.”

RainTree Oncology Services Launches Unique Pharmacy Network with Express Scripts

In other news, last week RT Services Oncology Corporation (aka RainTree) launched its expanded pharmacy network with Express Scripts. The partnership will serve to offer member oncology practices who dispense oral drugs “greater access to plans than any other Pharmacy Services Administration Organization (PSAO).”

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