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  • Congressional Subcommittee Reviews Physician Payment and Quality Issues



    Ensuring that Medicare physician reimbursement promotes quality care was a key topic of today’s House Energy and Commerce Committee Health Subcommittee hearing. The hearing, on implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-Based Incentive Payment System (MIPS) examined issues of adequate reimbursement as well as relieving administrative burdens to allow physicians to focus on patient care.

    The Infectious Diseases Society of America provided specific feedback on those issues in a letter to the subcommittee with an emphasis on policies needed to allow ID physicians to meaningfully participate in new payment models focused on quality of care. The letter highlighted the importance of ensuring that ID physician compensation accurately reflects the complexity of care ID physicians provide and is sufficient to attract the next generation of physicians to the subspecialty.

    The 2018 final rule of the MIPS and Alternative Payment Model Incentives Programs included many of IDSA’s recommendations to help ID physicians participate in these programs which are a key mechanism for rewarding physicians for improving patient care. Many challenges, however, remain, which IDSA is urging the Subcommittee to address. Implementation of antibiotic stewardship programs is a key area of MIPS in which ID physicians will be particularly able to participate in a meaningful way. We believe that the Centers for Medicare and Medicaid Services should designate stewardship as a high weighted improvement activity under MIPS, given its direct impact on patient care, safety and health.

    IDSA continues to stress that the current undervaluation of ID physician patient care and other cognitive care services (patient care services not associated with procedures) must be addressed in order for payment reform activities included in MACRA to have an impact on quality and value of patient care. More than 90 percent of the care provided by ID physicians is accounted for by evaluation and management cognitive encounters that, with codes that fail to reflect the increasing complexity of the services are undervalued by current payment systems compared to procedural patient encounters including those in cardiology, surgery and gastroenterology. This accounts for the significant compensation disparity between ID physicians and physicians that provide a greater proportion of procedure-based care. That disparity drives new physicians toward the better compensated, posing a serious challenge to the recruitment of new physicians to the infectious diseases field.

    IDSA will continue working with Congress and the Centers for Medicare and Medicaid Services to promote policies that will drive fair and accurate compensation, including provisions that will allow ID physicians to meaningfully participate in new quality-based payment programs, to help secure the future of the ID workforce.

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