Medicare: Legislative Update Kristin McDonald Director, Congressional Affairs Cancer Policy and Clinical Affairs Department American Society of Clinical Oncology
Medicare Physician Payment Reform and SGR Repeal: Strategy for the 114 th Congress
The 113 th Congress H.R. 4015/S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 After a decade of patches to prevent Medicare payment cuts, in 2014, the 3 congressional committees of jurisdiction reached a compromise to repeal and replace the Sustainable Growth Rate (SGR) House Energy and Commerce Committee House Ways & Means Committee Senate Finance Committee
Policy Broadly Supported Bipartisan, Bicameral Support Stakeholder Support: ASCO, and physician community at large, endorsed policy However: No consensus on offsets
Outline of Compromise Bill Repeals SGR immediately Provides positive annual update of.5% for five years (2014-2018) Streamlines current incentive payments into new system, the Merit-Based Incentive Payment System (MIPS) Provides 5 percent incentive payment for physicians in Alternative Payment Models Provides funding for technical assistance to small practices of 15 or fewer professionals for performance improvement Elevates the role of QCDRs
Merit-Based Incentive Payment System (MIPS) Streamlines PQRS, VBM and EHR MU into one incentive program effective 2018 Performance Assessment: Quality, Resource Use, EHR Meaningful Use, Clinical Improvement Activities Allows group practice reporting Prospectively-set performance thresholds - flexibility in application of performance requirements that are inappropriate for some specialties Penalty risks for those who fall in the lowest performance quartile has been capped at a maximum of 9 percent
Congress Failed to Act Prior to Adjourning the 113 th Congress March 2014: Congress passed a 1-year patch to avert the scheduled payment cut Postpones the discussion on how to pay for the cost of the legislation Current Cost of Repeal of the SGR: $131 Billion Amount Spent on SGR Patches : $169.5 Billion
What s Next for the 114 th Congress? In the next, 114 th Congress all three committees will again have to approve the policy and decide how to pay for the legislation. Challenges: New Committee Leadership Key Staff Turnover Pay-for Conversation Does Not Get Easier Should Policy Change? Could Lose Congressional and Stakeholder Support
What is ASCO Doing? ASCO Will Continue to Lobby, Deploy Grassroots and Educate Capitol Hill to Encourage Comprehensive Payment Reform
Alternative Payment Reform Models
Proliferation of Payment Reform Models for Oncology ASCO Model CMMI Model Center for American Progress PCMH
CONSOLIDATED PAYMENTS FOR ONCOLOGY CARE Payment structure - Patient centered - Better match to services we provide/patients need Simpler billing structure More predictable revenue stream Incentivize high quality, highvalue care Support coordinated, patientcentered care
CMMI Proposal Oncology Care Model (OCM) Episode of six months following initiation of chemotherapy. Traditional fee-for-service (FFS) payments A per-beneficiary per-month (PBPM) payment A retrospective risk-adjusted, performance-based payment Eight quality metrics intended for determining performance
Additional Ongoing Efforts Center for American Progress working on bundling proposal to be released in the coming months Ongoing work with Patient Centered Medical Home for Oncology/COME Home Project
SGR Repeal Bill Current Climate Encourages testing of specialty specific payment models Uncertain future CMS/CMMI Limited willingness to be innovative Room for discussion about OCM
Advocacy Activity Extensive education about ASCO model Preliminary discussions on Capitol Hill Met with and provided comments to CMMI about ASCO and CMMI model Discussion with Stakeholders Series of town halls with ASCO members
Additional Congressional Activity in the 113th ABLE Act: Passed Congress and Signed by President Obama in December with Problematic Pay Fors Accelerates Targeted Payment Cuts to the Fee Schedule Should Targeted Cuts not be Met, an Across the Board Cut will Occur Cuts Amounting to: 1% 2016,.5% 2017,.5% 2018 ASCO Tracking the Implementation of this Policy; Watching for the Targeting of Oncology Codes
Additional Congressional Activity in the 113 th Sequestration: April 1, 2013 Sequestration Cuts Began: 2% across the board Medicare provider payment cut December 2013, Ryan-Murray Budget Agreement Provided Partial Relief for Sequester Cuts for 2 Years Next Round of Sequestration Cuts Unclear ASCO will Continue to Monitor Activities Related to Sequester
And Much More Many More Opportunities for Congressional Participation on the Horizon Site Neutral Payment Medicare Reform Alternative Payment Models Both Positive and Negative; Offense and Defense
Questions? Kristin McDonald 571-483-1642 Kristin.McDonald@asco.org