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ASA Continues SGR Reform Discussion Tied to Quality

Tuesday, April 16, 2013

On April 15, ASA responded to a request for additional feedback from the U. S. House Committee on Ways and Means and the Committee on Energy and Commerce regarding their ongoing proposal to repeal the Medicare Sustainable Growth Rate (SGR), along with creating a new "Update Incentive Program (UIP)."

ASA suggested an important precursor to the development of any form of SGR repeal and replacement is establishing an accurate baseline and that replacement should "acknowledge and remedy" anesthesiology’s unique "33 percent problem."  ASA's response elaborated that while the Medicare Payment Advisory Commission (MedPAC) "has consistently reported Medicare pays around 80 percent of commercial pay rates for most medical care…[it] is markedly different when looking at anesthesia care." 

ASA also provided input on clinical improvement efforts by highlighting the Anesthesia Quality Institute and ASA efforts to develop quality measures.  However, ASA emphasized "more should be done to eliminate roadblocks in the measure development process" and that the "National Quality Forum (NQF) process serves as a bottleneck to incorporating these measures into the Physician Quality Reporting System (PQRS)."  ASA advocated that specialties should be able to take measures directly to the Secretary of Health and Human Services (HHS) and the Secretary should have a clear set of criteria to evaluate these measures.  ASA stated that if a measure was not accepted "the Secretary should provide a clear justification for why the measure was not accepted and how the measure can be refined and/or how the Secretary’s concern(s) can be addressed."  Additionally, ASA noted that incentive program measures should include outcome measures as well as high level process measures.

ASA offered additional suggestions for improvements to existing law, such as extending rural health pass thru payments to anesthesiologists and revising Electronic Health Record (EHR) standards to ensure participation by anesthesiologists. ASA also highlighted the Perioperative Surgical Home Model of coordinated care and expressed that any new advanced payment model should allow physicians "to participate in more than one payment model."

The committees maintained that their proposal to reform and possibly replace the SGR is still an evolving process and that they are likely to continue to solicit feedback from physician stakeholders. ASA remains committed to repealing and replacing the flawed SGR mechanism with a system that more accurately reflect the cost of providing care to Medicare patients.

Review the full response.
Review ASA's February response.

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