What SGR's end means to small practices

President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law yesterday afternoon on the patio of the White House Rose Garden, bringing to an end the era of Sustainable Growth Rate-derived physician payments.

Obama said the legislation would give Medicare doctors assurance about their payments. Medicare doctors would have been subject to a 21-percent payment cut effective at midnight Wednesday had the Senate not passed the "SGR-fix" legislation, which had breezed through the House in late March.

The president added that MACRA "starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied but whether or not people actually start feeling better. It encourages us to continue to make the system better without denying service."

Provisions of the law consolidate Medicare's quality reporting programs into a single merit-based incentive payment system (MIPS), which will "reduce the aggregate level of financial penalties [Medicare] physicians otherwise would have faced," according to a statement from the American Medical Association.

In addition, Medicare physicians will be eligible for incentive payments by participating in value-based care models and meeting specified thresholds.

The bipartisan bill includes $100 million in funding for technical support to help small practices participate in new payment models. The law states that the Department of Health and Human Services will enter into contracts with entities such as quality improvement organizations, regional extension centers or regional health collaboratives "to offer guidance and assistance to MIPS-eligible in practices of 15 or fewer professionals." The support will focus on how to transition to the implementation of and participation in alternative payment models.

Priority will be given to rural practices, locations with shortages of health professionals, medically underserved areas, as well as practices with low composite MIPS scores.

The funding will flow in outlays of $20,000,000 for each of the fiscal years 2016 through 2020.

The AMA pointed out another MACRA provision that should be beneficial for physicians: The legislation includes protections that prevent medical liability cases from using Medicare quality program standards and measures as a standard or duty of care.