What's Not to Like About Uncle Sam Relaxing Enforcement?


When the head of the Medicare program revealed that his agency planned to relax how doctors could report data for the first year of the upcoming pay-for-quality system, the cheers from almost all health groups was enthusiastic.

“This is the flexibility that physicians were seeking all along,” the American Medical Association said.

The American Academy of Family Physicians said it was in favor of the recommendations for allowing physicians to choose the pace at which they will move toward the new quality payment program. The group had asked for flexibility in launching the 2017 reporting performance year that will be the basis for Medicare reimbursements in 2019.

And from Capitol Hill, the heads of the House committees with Medicare responsibility also cheered the flexibility offered, which will help “ensure this historic law delivers the quality, value-based care Medicare beneficiaries deserve.”

We could go on.

In his tease on the contents of the final rule on the pay-for-quality system now being reviewed by the White House, the agency’s acting administrator, Andy Slavitt, had said that doctors don’t have to participate for the full calendar year in order to avoid penalties that first year. Instead, they could test the quality payment program and participate on a limited basis.

The feds promising to ease up enforcement, and worries about a Medicare pay cut somewhat allayed, what’s not to like?

But the cheers weren’t unanimous.

Imagine having spent resources getting ready for a new approach, expecting something nice in return, only to be told that it may not be what you were expecting.

That’s what bothered the AMGA, an association for multispecialty medical groups.

“Our membership is deeply concerned that the creation of these new reporting options will have the unintended result of penalizing the very provider groups that have made the largest investments” AMGA said.

These more prepared medical groups that have already begun the transition to the new systems have invested in people and IT to deliver better care, AMGA said in a statement a few days after Slavitt’s Sept. 8 announcement.

They will be disappointed that rewards for their efforts will be compromised rather than rewarded, the group said.

In 2019, doctors will receive a performance score that could lead to 4 percent cuts or increases to their Medicare reimbursements. But because the upcoming reporting system must be budget neutral, allowing doctors to submit some data to avoid a negative payment adjustment “compresses the range of awards,” AMGA said.

In other words, since the pool of money has to remain constant, if fewer practices are being cut because of the looser standards, fewer will get an increase.

It’ll be “tough for a high scoring group to earn an additional 4 percent if there are not any providers below a zero score,” an AMGA spokeswoman told me.

But the tease was just that. Until the rule comes out within the next six weeks, the details remain to be seen.

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