Leaders of the GOP and Democratic Doctors’ Caucuses have introduced legislation, titled the Patients First Act (H.R. 9693), that would reform how Medicare pays physicians by updating the 2015 Medicare Access and CHIP Reauthorization Act (MACRA).
Introduced by Reps. Greg Murphy, MD (R-NC), John Joyce (R-PA) and Kim Schrier (D-WA), the bill would tie annual Medicare physician payment updates to the Medicare Economic Index (MEI). The bill does not update payments by the full MEI amount and sets upper and lower limits on how much the Medicare physician fee schedule conversion factor could rise or fall.
The bill also replaces the Merit-based Incentive Payment System (MIPS) with a new program — the Patient Outcome Improvement National Tabulation System (POINTS) — which puts medical societies in the driver’s seat for identifying measures appropriate to their specialty and better recognizes clinical data registries for quality measure reporting and performance assessment. POINTS would include three performance categories, maintaining the quality and resource use categories and adding a new efficiency category that would measure things like reductions in avoidable hospitalizations and referral patterns to the lowest cost clinically appropriate care setting.
Of note, the bill sets a limit on POINTS bonus payouts for non-independent providers at 50 percent of the total adjustment and redistributes the delta to independent providers.
The bill also includes important reforms Medicare physician fee schedule budget neutrality requirements including raising the threshold that triggers cuts to the Medicare conversion factor from $20 million to $57.64 million and indexing it to the Medicare Economic Index every five years.
Read the press release here.
Read the section by section here.
Read the full bill text here.