House panels release new outline for permanent 'doc fix'

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The accompanying letter emphasized the importance of tailoring a permanent doc fix to different medical specialties.

"Designing a system that is inclusive of all specialities and practice types presents a great challenge, and this draft makes a concerted effort to avoid a 'one size fits all' approach in favor of a versatile and inclusive process that provides for the maximum amount of individual choice," the lawmakers wrote.

Reps. Fred Upton (R-Mich.), Dave Camp (R-Mich.), Joe Pitts (R-Pa.) and Kevin Brady (R-Texas) are leading the SGR repeal effort in the House and composed the letter. Upton and Camp lead the Energy and Commerce and Ways and Means Committees, respectively, while Pitts and Brady lead those panels' Health subcommittees.

Congress has struggled with the SGR for years. The formula precipitates regular almost-crises for Medicare physicians, confronting them with dramatic payment cuts unless lawmakers act.

The House plan to repeal the SGR divides the reform into several phases.

In the first phase, Medicare doctors would see several years of stable payments, ordered by statute.

This stage would allow each medical specialty to develop quality and efficiency measures that will be used to score their performance down the line as part of a new payment formula.

Phase two would allow care quality to begin to impact doctors' Medicare reimbursements. Physicians would receive a base payment, and on top of that, a variable payment determined by their performance.

Phase three, the last stage, would make efficient use of healthcare resources a priority by incorporating it as another factor in doctors' pay.

Throughout the new document, lawmakers pose questions to healthcare stakeholders, encouraging them to provide feedback on a range of topics related to delivery-system reform.

The draft builds a previous one released Feb. 7 by adding several new emphases.

"This proposal includes processes fro determining quality and efficiency measures that focus on evidence while being flexible and specialty-specific," the lawmakers wrote to healthcare providers.

"This proposal recognizes the important role that [specialty-specific] registries can play to facilitate quality improvement while minimizing provider participation burden."

Lawmakers added that they understand providers' need for "timely performance feedback" from federal health officials in order to "optimize incentive payments" in the new system.