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Debate over SGR Fix and Opioids Guidance heating up

Doctors were pressing the Congress over a permanent SGR fix. In the meantime, Congress presses the FDA to publish the guidance on abuse-deterrent opioids.

Sen. Sheldon Whitehouse (D-R.I.) , a member of the Senate Health, Education, Labor and Pensions Committee, argued that Meaningful Use rules need a dramatic rewrite, and a new study from the American Medical Association and RAND takes a closer look at various alternative payment models and their impacts on practices large and small.

Negotiations Heat Up on Permanent SGR Fix

As a deadline looms, Congressional negotiators are continuing their efforts to negotiate a permanent repeal for the sustainable growth rate (SGR) formula for physician reimbursement under Medicare, including finding a way to pay for it.

“Last year, the Ways and Means and Energy and Commerce Committees came together, on a bipartisan basis, to propose a permanent alternative to the broken SGR system,” the leaders of the House Ways and Means and Energy and Commerce committees said in a joint statement issued last Friday.

“We are now engaging in active discussions on a bipartisan basis — following up on the work done by leadership — to try to achieve an effective permanent resolution to the SGR problem, strengthen Medicare for our seniors, and extend the popular Children’s Health Insurance Program [CHIP].”

The current “patch” to the SGR expires on March 31. After that, physicians will face a 21.2% cut in Medicare reimbursement unless Congress steps in with either another patch or a permanent repeal. During the last session of Congress, a bipartisan “SGR fix” bill — supported by both Democrats and Republicans — won the support of the two House committees as well as the Senate Finance Committee. But the bill didn’t pass Congress, largely because members couldn’t agree on how to pay for it.

Congress Pressures FDA to Finalize Opioid Guidance

The FDA will publish its long-awaited guidance on abuse-deterrent opioids by the end of June, in order to avoid a $20 million cut in funds to the commissioner’s office threatened by Congress.

An amendment by Hal Rogers (R-Ky.) to the “Cromnibus” appropriations bill passed last December requires that the guidance be finalized by June 30, otherwise $20 million will be moved from the salaries and expenses section of the FDA Commissioner’s office to its criminal investigations department to combat drug diversion.

Rogers is chair of the House Appropriations Committee.

Meaningful Use Needs ‘Reboot,’ Senator Says

The Meaningful Use program aimed at getting more providers to use electronic health records (EHRs) needs a “reboot,” Sen. Sheldon Whitehouse (D-R.I.) said at a hearing on Tuesday.

The Meaningful Use rules “started from a little bit of a disability — basically it was the equivalent of subsidizing cars and penalizing people for not buying cars, and then figuring out they’re going to go and build the roads on their own,” Whitehouse, a member of the Senate Health, Education, Labor and Pensions (HELP) Committee, said during a committee hearing on the promise of EHRs. “That’s a pretty fair analogy for what the problem has been for health information exchange.”

One of the problems with the current program is that nursing homes and behavioral healthcare facilities weren’t included, Whitehouse said. “If you’re looking at the expensive people in the healthcare system, a lot of them are cycling between nursing homes and the healthcare system. If you don’t require nursing homes to cooperate, you’ve made a stupid tactical error in the rollout of health information technology. Ditto if you’re a patient with a behavioral health issue.”

Transparency: Physicians’ Friend, Not Foe

Physicians can play a critical role in advancing healthcare transparency and transformation, but they must be willing to tolerate change and criticism, said health and policy experts at the Summit on Healthcare Price Cost and Quality Transparency here on Monday.

As consumers have become more aware of their health costs and choices, physicians are learning how to help support patients in their decisions, said Divya Sharma, MD, MS, medical director for Central Oregon’s Independent Practice Association and medical director for the complex care center at Mosaic Medical, a federally qualified health center (FQHC) in Bend, Ore.

The old physician approach was “I will tell you what you need to do. You don’t get to question it,” Sharma said. That mentality has diminished. Now patient consumers have armed themselves with more information, and they are less inclined to blindly follow orders. Still they want guidance from their doctors. “They’re coming [to me saying], ‘Tell me why I should do this. And how much is this going to cost?’” Sharma said.

Study Drills Down Into New Pay Models

Managing new alternative payment models is a little like playing a video game: providers chase points to earn rewards and duck blows meted out after too many missteps.

“You lose sight of [whether] this is really having true clinical impact,” said the leader of a large multispecialty practice cited in a recent study conducted by the American Medical Association and RAND Health.

To better understand the effects of implementing alternative payment systems, researchers assessed 34 practices in six markets between February 2014 and March 2015.

Next Week

On Tuesday, the Senate Health, Education, Labor and Pension Committee meets to discuss advancing research and development for patients.

On Wednesday, The House Appropriations Committee will meet to discuss the Centers for Disease Control and Prevention budget.

On Friday, the Alliance for Health Reform is holding a briefing, Medicare 101: What You Need to Know.

About Rachell M.

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