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Letter from the Editor, #780

May 7, 2015

On April 16, President Obama signed into law the Medicare Access and Children’s Health Insurance Program Reauthorization Act. This law does away with the sustainable growth rate (SGR) for Medicare payments for patient care, which was designed to hold down spending and consistently reduce physician payments.

Under the new law, there will be annual increases in payments of 0.5%, beginning July 1 and continuing until the end of 2019. Then in 2019, existing Medicare quality-reporting and incentive programs, including the Physician Quality Reporting System, Value-Based Payment Modifier, and Meaningful Use, will be consolidated into a single program, dubbed the Merit-based Incentive Payment System.

Under this system, physicians will get credit for quality-improvement initiatives, and there will be strong incentives to transition to the patient-centered "medical home" model of care, according to Robert Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians.

It will also be possible for high-performing physicians to earn additional payments from a pool of up to $500 million per year from 2019 to 2024 from new funds as part of the Merit-based Incentive Payment System. There will also be a pool of $20 million annually specifically to help smaller practices.

The new payment rules will require that providers choose between merit-based and alternative payment models, such as accountable care organizations and advanced patient-centered medical homes. However, providers will be able to change payment preferences annually, so if a particular practice does not fair as well in one year, they could change the method to maximize potential.

For those of us who are concerned that our diabetes patients will drag down these future ratings, now would be a good time to examine the new Medicare Diabetes Prevention Act and try to refer as many patients as possible before they get diabetes.


Announcements: Sunday, May 9, 7PM ET

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TCOYD Health Fair Conference, Overland Park Convention Center, Overland Park, Kansas, Saturday, May 16, 2015

With a day packed full of education, motivational tools, one-on-one sessions, and workshops, the TCOYD health fair is a great way to get your patients to take better care of their health and themselves.

We can make a difference!


Dave Joffe, Editor-in-chief