General Surgery Coding Alert - 2005 Issue 30
Pay-for-Performance: New House Bill Would Repeal Update Formula
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Article Overview
This article examines a pending House bill affecting Medicare physician payment updates, including a proposed repeal of the Sustainable Growth Rate formula and a shift toward pay-for-performance or value-based purchasing. It discusses the roles of physician specialty organizations, the National Quality Forum, and CMS in shaping quality measures and future payment updates. The piece is relevant to physicians, specialty societies, health policy professionals, and coding or reimbursement stakeholders tracking Medicare payment policy.
Why This Topic Matters
The article covers proposed changes that could affect how Medicare physician payments are updated and how quality measures are developed, which is important for organizations monitoring reimbursement policy and performance-based payment models.
Article Sections
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Proposed House bill and payment update changes
Overview of the pending legislation and the broader Medicare physician payment update framework it would replace.
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Physician quality measures and specialty society input
Discussion of how specialty groups may participate in recommending quality measures and how those recommendations would move through an outside review process.
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CMS response and SGR-related concerns
Coverage of agency testimony and correspondence regarding the current formula, administrative limits, and the impact of potential changes.
What You Will Learn
- How the proposed legislation would change Medicare physician payment updates
- How pay-for-performance and value-based purchasing are being incorporated into the proposal
- How specialty societies and outside agencies are expected to participate in quality measure development
- What concerns were raised about the process for reviewing quality measure recommendations
- How CMS responded to questions about the existing payment update formula
Who Should Read This
- Physicians
- Physician specialty societies
- Medical practice administrators
- Health policy professionals
- Medicare reimbursement stakeholders
- Coding and compliance professionals
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