CAP Improves Quality Programs for Pathologists, Supports “SGR Repeal and Medicare Provider Payment Modernization Act”
February 11, 2014—Representing a significant victory for pathology in the effort to repeal the sustainable growth rate (SGR) and reform Medicare physician payments, the Senate and House Committees’ bipartisan bicameral policy agreement, HR 4015/S 2000 includes a provision backed by the College of American Pathologists (CAP) that provides more flexibility for pathologists to meet requirements under Medicare’s Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Incentive Program, and the Value-Based Modifier (VBM). The bill would permanently repeal the flawed SGR formula and over time, implement a new merit-based incentive payment system (MIPS) that, in part, ties payment to a physician’s performance in these value-based programs.
The CAP-supported provision specifically allows the US Secretary of Health and Human Services Secretary to use alternative measures to assess a pathologist’s performance in PQRS, EHR Meaningful Use, and the VBM. This addresses CAP’s long-held concerns that such quality initiatives were designed for office-based physicians and are problematic for pathologists practicing in the laboratory.
The much-needed provision was first included in SGR legislation reported out of the House Ways and Means Committee on December 5, but it was not included in either the House Energy and Commerce Committee’s version of the bill or the version considered by the Senate Finance Committee.
However, lawmakers have not reached agreement on how to pay for the bill, which is estimated by the Congressional Budget Office to cost in the range of about $130 billion to $150 billion over the next decade.
The CAP is particularly pleased that the new bipartisan, bicameral legislation retained the pathology provision, helping to ensure that all physician specialties, including pathology, can participate in the MIPS and receive credit for their quality contributions to patient care. The legislation also provides physicians with a .5% annual payment update for a five-year period. This stability will help pathologists meet the needs of their patients while transitioning to a new payment system.
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