Senate Passes Permanent ‘Doc-Fix’ that Incorporates Cantwell-authored Reform

Medicare Access and CHIP Reauthorization Act repeals Sustainable Growth Rate, builds on Value Based Modifier provision

WASHINGTON, D.C. – Today, the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act, which reforms the way Medicare pays physicians by building on a provision Senator Maria Cantwell (D-WA) authored that is based on the quality of care rather than the volume of services.

The bill incorporates Cantwell’s Medicare Value Based Modifier into a new “Merit-Based Incentive Payment System (MIPS)” that will start in 2019. The new system bases physician payments on a composite score of four factors, including quality, efficiency, clinical practice improvement, and use of electronic health records. It scores physicians on performance, rewarding high performers with a bonus.

The Senate passed the legislation on a 92-8 vote. The bill passed the House on March 26 and now goes to the President’s desk for his approval.

“We think moving off a fee-for-service model and onto a system that focuses on the outcomes of patients is the best way for our country to move forward,” Cantwell said in a colloquy with Senator Ron Wyden (D-OR) on the Senate floor.

“We’re saying we want physicians to be rewarded for the outcome, for good performance, and the focus on whether the patient is well and given the best health care delivery,” Cantwell said. “In essence, the Value Based Modifier seeks to emulate the success that Washington and Oregon have had and that gives us better, healthier outcomes for patients at lower costs.”

The legislation permanently repeals the Sustainable Growth Rate – the current formula for determining annual updates to Medicare physician payments.

The bill also extends funding for the Children’s Health Insurance Program (CHIP) and other expiring health care programs for two years. Cantwell supported an amendment that would have extended funding to the CHIP program for four years. Also included in the bill is a Cantwell-authored provision requiring the Secretary of Health and Human Services to study the feasibility of integrating alternative payment models into the Medicare Advantage system.

Cantwell has led efforts to reform the Medicare reimbursement system and authored the Medicare Value Based Modifier as part of the Affordable Care Act of 2010.