Reforming Payments to Physicians for Medicare Beneficiaries

By the first quarter of 2014, the National Coalition for Cancer Survivorship (NCCS) and its colleagues in the cancer advocacy community may see substantial progress toward a Medicare payment system that rewards quality and focuses on care planning and coordination. These core principles have been advanced by NCCS and its colleagues through their emphasis on development of cancer care plans for all Medicare beneficiaries diagnosed with cancer.

For almost a decade, NCCS has pushed for reforms in the Medicare payment system to encourage cancer care planning and coordination. NCCS has maintained that these specific reforms – critical to improving the quality of care in a fee-for-service system – should be part of a larger overhaul of payment reform. The Planning Actively for Cancer Treatment (PACT) Act, introduced by Representatives Lois Capps (D-CA) and Charles Boustany (R-LA) in the 113th Congress, would establish cancer care planning and treatment codes in the Medicare program.

In the last several months, the Congressional committees with jurisdiction over Medicare physician payment have developed comprehensive packages that would: 1) eliminate the sustainable growth rate formula that has threatened deep cuts in physician payments each year in the last decade and that Congress has addressed each year to prevent the cuts, and 2) move the overall payment system toward alternative payment systems that reward quality and at the same time establish a quality reporting system and incentive payments for those physicians who remain in the fee-for-service system.

The House Energy and Commerce Committee has approved its version of a Medicare physician payment reform, and the House Ways & Means Committee and Senate Finance Committee are slated separately to approve their joint package before Congress adjourns. Because Congress will not be able to complete action on physician payment reform legislation by year’s end, it will probably approve a short-term package that blocks the cuts in payment that would be triggered by application of the sustainable growth rate formula and that also provides time for deliberations on the repeal of the formula and the design of broader, more comprehensive reforms.

NCCS has signaled its support for the Ways & Means-Finance physician payment reform package, while urging some enhancements of its provisions. In general, NCCS supports the movement away from a payment system that rewards volume of services over quality of care. The bipartisan, bicameral package addresses that issue by encouraging physicians to embrace alternative payment systems, like patient-centered medical homes and accountable care organizations. For those physicians who choose to remain in the fee-for-service payment system, incentive payments are available if one is engaged in certain quality improvement activities. One of the key quality improvement activities is care planning and coordination.

In addition, the Ways & Means-Finance package would establish one or more codes for management of patients with complex chronic conditions. These codes would be utilized while the more fundamental changes in physician payment are implemented.

NCCS outlined its ideas for improving the bipartisan reform package in a letter to the Finance and Ways and Means Committees.

NCCS also joined its colleagues in the patient advocacy community in an additional letter to the committees. The Cancer Leadership Council letter echoed many of the concerns that NCCS outlined in its letter to the committees and also recommended that encouraging clinical trials enrollment be considered a quality activity that would qualify physicians for incentive payments.

NCCS CEO Shelley Fuld Nasso penned an opinion piece regarding the bipartisan, bicameral physician payment reform package that was published online in The Hill.