Medicare Reform Legislation Repeals SGR, Consolidates Incentive Programs

Dr. Denneny said that while the patches were aimed at preventing marked decreases in physician payments, the new legislation now allows for stability in Medicare payments. “Knowing that they won’t face huge cuts will allow practitioners to expand their practices by buying new technology or equipment or offering new services that will improve patient care,” he says.

The new legislation is expected to help build a more efficient, sustainable, and fair Medicare physician payment system.

The legislation also repeals the recent Centers for Medicare and Medicaid Services policy to transition all 10- and 90-day global payment codes to zero-day codes by 2018. “Within the bill, MACRA mandates that CMS produce data in 2017 before proceeding with this,” Dr. Denneny said. “This particular mandate by CMS last year was potentially devastating if the same process was also implemented in the private payer market. Patients could be faced with multiple copays for hospital visits and post-operative visits—which some people couldn’t afford. As a specialty, we felt that this would decrease the quality of care and didn’t fit in with the direction of healthcare reform.”

Quality Reporting Overhaul

The new legislation also consolidates three existing performance-based programs (the EHR meaningful use incentive program, the Physician Quality Reporting System, and the value-based payment modifier established under the Affordable Care Act) into a unified Merit-based Incentive Payment System (MIPS). “Physician payment will no longer be based solely on the volume of services, but also on the quality and value of physician’s care,” said Dr. Randolph.

Dr. Denneny believes that MACRA-mandated consolidation of the existing performance-based programs in Medicare will simplify the quality reporting process. MIPS will evaluate performance of physicians in four categories: quality of care, resource use, meaningful use, and clinical practice improvements (see “MIPS Performance Category Weights,”).

The legislation also allows providers who participate in alternative payment models to opt out of MIPS.

AAO-HNS has guidelines that outline standards of care for otolaryngology-specific disease processes and is creating metrics that can be used to define, measure, and report otolaryngologic quality. “This work is epitomized by the academy’s new initiative to form an otolaryngology registry to provide quality metrics,” Dr. Randolph said. “It is essential for otolaryngologists to participate in this process in order to define quality in a way that truly makes sense within our field.”

MACRA allows Qualified Clinical Data Registries (QCDR) to be used to report quality measures under the new MIPS program, Dr. Denneny said. “MACRA codifies the fact that we will be able to use QCDRs for quality reporting. This is extremely important, given the fact that we are proceeding with the formation of our own QCDR,” he added.