Illustration: Annelise Capossela/Axios
Congressional activity around reforming how Medicare pays doctors is picking up steam this year — though the cost and tight legislative calendar make a major overhaul unlikely, sources say.
Why it matters: Action could both avert the annual rite of reversing scheduled Medicare cuts to physician pay and kick start long-running efforts to more closely tie compensation to quality care.
Driving the news: Senate Finance Chair Ron Wyden and Ranking Member Mike Crapo released a white paper on Friday to accelerate the discussion.
- It posed questions like how to update payments to account for inflation, and how to better incentivize doctors to participate in advanced alternative payment models that reward healthier outcomes for patients.
- Sens. Sheldon Whitehouse and Bill Cassidy also unveiled a bill to enhance value-based pay for primary care providers.
- Another bipartisan group including Sens. Catherine Cortez Masto and Marsha Blackburn have a working group on Medicare payment reform.
- Some retiring House lawmakers who are doctors could also want some action before they leave.
What they're saying: "The plan is to build towards legislation — likely first a discussion draft ... sometime this year," a Senate aide said. "The hope is to have some provisions ready for lame-duck consideration, with the recognition that doing everything needed will likely take longer."
- Wyden told Axios, "We'll see" if doctor payment reforms can be part of a lame duck package. "We're going to prosecute the case as hard as we can. ... We've got a lot on the plate," he said.
Yes, but: Despite the heightened interest, a large-scale overhaul of doctor pay is likely too much for Congress to take on this year, given the time needed to refine proposals, cost concerns and the broader dysfunction around finding a must-pass legislative vehicle for a "doc fix."
- That argues for narrower steps that, at a minimum, could partially offset cuts from the annual physician fee schedule, as has been done in prior years.
The big picture: The efforts to help Medicare physicians are still in the relatively early stages, with key lawmakers gathering feedback.
- "There are things that can be done by the end of the year laying the groundwork for a bigger bill in the future," said Mara McDermott, CEO of Accountable for Health, a group seeking to accelerate the shift to new payment models and clarify the current incentives for doctors.
- Susan Dentzer, CEO of America's Physician Groups, said the Finance Committee white paper had some good ideas, but she wants a "major push" toward advanced alternative payment models.
- "They're really talking about kind of small bore things that could be done," she said.
