Home > EHR, meaningful use, Medicare > SGR and the Merit-Based Incentive Payment System Revisited

SGR and the Merit-Based Incentive Payment System Revisited

Legislation to replace the Sustainable Growth Rate (SGR) formula passed the U.S. House of Representatives on March 26, and could pass the Senate following the Congressional recess. As with last year’s failed legislation to permanently fix the SGR, certain language meant to encourage “pay for performance” would significantly impact the landscape of health IT policy.

The included “Merit-Based Incentive Payment System (MIPS)” concept would consolidate the three active Medicare incentive programs—the Physician Quality Reporting System (PQRS), EHR Incentive Program (“meaningful use”), and Value Based Modifier (VBM)—into an umbrella carrot-and-stick program that eligible professionals could do as an alternative to mandated participation in alternative payment models (APMs). MIPS would award incentive payments or payment reductions based on a “composite performance score” of 0-100 comprised of activities in four areas: quality, resource use, meaningful use, and clinical practice improvement activities. This score-based system would replace the current Medicare programs’ payment adjustments with potentially bigger reductions for some physicians; however, most physicians would avoid penalties or obtain incentive bonuses.

As was the case last year, the bill directs regulators to consider the applicability of the various requirements that comprise the composite performance score to “non-patient-facing” professionals and others. This language could conceivably result in alternative pathways to compliance, removal of individual programs (such as MU and VBM) from the score for certain professionals, or even 1:1 replacement requirements for non-patient-facing professionals that fulfill the same goals.

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Categories: EHR, meaningful use, Medicare

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