Congress Aims to Fix Medicare Doctor Payouts Starting in 2014

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The Medicare Patient Access and Quality Improvement Act of 2013, passed 51-0 by the House Energy and Commerce Committee on July 31, calls for an end to the current Medicare payment formula, which doctors say has underpaid them for years. The Act, also known as House of Representatives bill 2810, aims to increase payments to doctors serving Medicare patients beginning in 2014. - MedicareMall.com

U.S. House of Representatives bill 2810

U.S. House of Representatives bill 2810

Inflation is causing doctors’ costs to far outpace what they are being paid by Medicare. This is the reason that a lot of doctors have started to limit the number of Medicare patients that they will see, or have stopped taking Medicare patients altogether.

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Unanimous passage of U.S. House of Representatives bill 2810 by the House Energy and Commerce Committee on July 31 is widely viewed as a key step toward fixing a Medicare payment formula that many doctors have described as unfair.

The current payment formula, called Sustainable Growth Rate (SGR), has governed Medicare payments to doctors since 1997. Payments under SGR are tied to GDP projections, and critics say that because those projections have been low, doctors serving Medicare patients have been underpaid for over a dozen years.

According to bill sponsor Rep. Michael Burgess, M.D. (R-Tex.), under the current payment formula “Inflation is causing doctors’ costs to far outpace what they are being paid by Medicare. This is the reason that a lot of doctors have started to limit the number of Medicare patients that they will see, or have stopped taking Medicare patients altogether.”

H.R. 2810, also known as the Medicare Patient Access and Quality Improvement Act of 2013, “repeals the flawed sustainable growth rate (SGR) system and replaces it with a fair and stable system of payments,” according to the House Energy and Commerce Committee.

H.R. 2810 calls for Medicare reimbursement to doctors to increase by 0.5 percent annually from 2014-2018. Although this is not an increase designed to keep up with inflation, Burgess describes the bill as “a solution that is good for both doctors and Medicare patients.”

H.R. 2810 also calls for doctors serving Medicare patients to be subject to performance review under a new Updated Incentive Program (UIP) beginning in 2014. It is expected that assessment will be based on adherence to established standards and procedures, and ability to keep patients healthy while keeping costs to Medicare relatively low.

Doctors assessed as superior will receive a 1 percent payment bonus, while doctors assessed as low-performing will be subject to a 1 percent penalty. Doctors failing to provide adequate information for assessment will face a 3 percent penalty under the UIP.

The fate of H.R. 2810 is not yet certain, as the bill still needs to passed by both houses of Congress and signed by the President before it can become law. But it is widely viewed as a significant sign that Congress is determined to find a lasting solution to a problem that has been undermining the Medicare system for years.

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