Burgess finds fix for Medicare issue

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Often, it seems like Washington can never get things done. Problems fester while solutions remain elusive. But to his credit, Dr. Michael Burgess, R-Lewisville, has defied the odds. The House member has found a bipartisan way to fix the way Medicare reimburses physicians.

Before you tune this out as C-Span fare, remember that whatever formula Medicare uses affects whether seniors will have enough doctors to choose from as they seek care. And Congress’ seemingly eternal inability to find a sustainable formula contributes to Medicare’s financial struggles. Those problems affect families and taxpayers alike.

The way the payment system now works is Congress approves a formula that usually leads to cuts in reimbursements. Next, doctors squawk. Soon, legislators relent, not wanting doctors to leave Medicare en masse.

Washington goes through this song and dance almost yearly, putting patches on the formula but never fixing the system. Here, though, is where Burgess comes in.

He recently got his reform of the payment system through the House Energy and Commerce Committee with support from Democrats and Republicans. In fact, the committee approved HB 2810 by a 51-0 vote in late July.

The key part is the measure would give physicians incentives to offer quality service and do their work efficiently. Here’s how:

After a five-year transition period, doctors would be reimbursed based on their ability to meet certain quality measures. American medical societies would help determine the metrics, Burgess explained when he met with the Dallas Morning News editorial board recently. Then, the Health and Human Services secretary would finalize the measures each year.

Doctors would be rewarded or penalized depending upon how well they do with the metrics. If they meet the quality benchmarks, they will do well. If they don’t meet the benchmarks, they will get paid less.

Several medical groups say they see this proposal as a work in progress. Undoubtedly, there are ways to tweak it. But it does emphasize quality services. That’s part of the new medical model that reformers rightly have been promoting over the last decade.

Yes, the formula will cost money. The Congressional Budget Office estimates $139 billion over a decade.

Not chump change, but annually patching the system could cost even more and leave seniors in a state of uncertainty.

That doesn’t make sense, not when Burgess has a sensible alternative. The full House now needs to work on a funding mechanism. Perhaps there is a way to wrap this up into a grand budget bargain. Washington then could finally fix this problem.

How Burgess’ plan would reimburse physicians after a five-year phase-in period:

If doctors meet the metrics well enough that they finish in the top third of their specialization, they would receive a 1.5 percent bonus from Medicare.

They would get a 0.5 percent bonus if they finish in the middle third of their specialty.

They would suffer a 0.5 percent penalty if they score in the bottom third.

Doctors who do not participate in this approach would face a 5 percent reduction in reimbursement fees.

The Dallas Morning News


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