$128B SGR Repeal Deal Needs a Payment Plan

Christopher Cheney, for HealthLeaders Media , February 10, 2014

Schwartz's aide said the two-phase transition will allow time for innovation among accountable care organizations, and time for the best ACO models to become more apparent. "This gives us a test period to make sure those work," she said.

Assessing an Paying for Quality
Under the SGR repeal deal, the first major value-based reform would take effect in 2018, when a new quality assessment system is slated to start. According to a document detailing the deal, "In 2018, it establishes a streamlined and improved incentive payment program that will focus the fee-for-service system on providing value and quality."

While Sherman applauded streamlining Medicare's quality assessment efforts into one system, he said creating performance standards for doctors will only work if the "markers" are objective.

The NH gastroenterologist said some procedures in his field lend themselves to objective measurement but others will be harder to gauge for value. Sherman said the "withdrawal time" in a colonoscopy, when a doctor is most focused on finding abnormalities such as polyps, has been proven as an objective measure of physician performance. Withdrawal times faster than 6 minutes are considered at risk of compromising accuracy, he said. "If you go too fast, you're going to miss things," Sherman said.

But treatment of gastrointestinal conditions such as irritable bowel syndrome is hard to quantify, he said. "How do you attach objective measures to such a complex set of symptoms?" the NH physician-lawmaker asked.

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