Robert Wanerman, a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, office, was quoted in an article titled “House GOP Floats New Details of SGR Reform Plan.“
Following is an excerpt:
Signaling that they’ve heard the concerns of organized medicine, House Republican leaders provided more details to the physician community on how they plan to repeal Medicare’s sustainable growth rate formula and transition to a system that would guarantee payment stability while rewarding care quality and efficiency. ?…
Physician incentives for better care coordination certainly would make the Medicare program more efficient, because beneficiaries often have multiple physicians who don’t talk to one another, said Robert Wanerman, a partner in the health care and life sciences practice of Epstein Becker Green PC in Washington.
What the House GOP proposal has yet to flesh out is how one would chart those individual quality measurements, Wanerman said. It’s already known that a gap exists between what physicians do and what they actually document. This has been a contentious issue with physicians, “because there are a number of cases where insufficient documentation has been considered fraudulent,” he said.
The question becomes how this would play into the quality metrics that would be developed. “If you’re just reviewing what a physician documents, does that capture everything they did, some of what they did? That’s a potential Achilles heel in attempting to provide incentives for quality of care,” he said.
Wanerman also said there were no specifics on how primary care physicians might be treated differently from specialists under the new incentives-based system. “I didn’t see any sort of carve-out or any kind of protection for primary care, because, presumably, primary care would help to drive either lower costs or smaller increases in the rate of utilization.”