Iowa Medical Society
www.iowamedical.org

Braley brokers deal to create quality-based measurements in Medicare

July 24, 2009

Rep. Bruce Braley (D-Iowa) reached a deal with the Speaker and the Chairmen of the Committees of jurisdiction over health care to add language similar to his Medicare Payment Improvement Act to the House Health Care Reform bill. IMS President Michael Kitchell, MD, says this "is a huge breakthrough and a milestone for changing the direction of health care in this country."

Rep. Braley was accompanied by Reps. Kind, Inslee, and McCollum, who were representing a much broader 'Quality Coalition,' who have been pushing for a 'value index' in the Medicare Part B reimbursement equation to measure quality and efficiency of care.

Specifically, the deal will do the following:

Quality-Based Care -

  • Instruct IOM to study how to implement a 'value index' in the Medicare payment system. They will consider geographic differences, access to care, measures of quality, and the role of incentives to impact quality and efficient outcomes of care.
  • After a set two-year timeframe, IOM will make recommendations to the Secretary of HHS on how to specifically change the Medicare payment system to promote "high-value care," defined as the "efficient delivery of high quality, evidence-based, patient-centered care."
  • The Secretary will then submit a 'plan of implementation' to the Congress, to implement the recommendations of the IOM.
  • Congress will have a finite amount of time to pass a joint resolution of disapproval. If Congress fails to act, or if the recommendations are not expressly disapproved by both Chambers, then the recommendations of the IOM will be implemented, thereby reforming the Medicare payment system to incentivize high-value care.

Addressing Geographic Disparity -

  • In addition, the deal resulted in substantive action to address geographic disparity in Medicare payments. IOM will do another study, completed within a year after enactment, to determine whether the data and assumptions used to determine the geographic adjusters (Geographic Practice Cost Indexes and Wage Index) are accurate, or based on flawed data. Many believe the factors that determine these indexes are based on flawed data.
  • Upon completion of the study (within one year), the Secretary will take immediate action to adjust the GPCIs and Wage Index to ensure they are based on accurate data.
  • A "Medicare Improvement Fund" is established, which will consist of $8 billion. From this fund, payments will immediately be made in 2012 and 2013, to ensure the money is there for regions who see an increase in their reimbursement due to the adjusted GPCIs and Wage Index.
  • In 2012 and 2013, a 'Hold Harmless' will exist to ensure that payments do not decrease in any region as a result of these more accurate measurements. The 'Hold Harmless' expires after 2013, to allow budget neutrality for all appropriate shifts that must be made due to correcting the data in the long-term.