Roe’s role critical in potential landmark Medicare bill

By Jeff Keeling

If it becomes federal law, House Resolution 2 would change Medicare dramatically for doctors and hospitals, and could be the first step toward getting the huge entitlement program’s spending under control, First District Congressman Phil Roe (R-Johnson City) said Friday. The retired obstetrician, who was smack in the middle of the bipartisan legislative triumph last week, said the bill that will impact Medicare for years to come didn’t materialize overnight.

“This represents six years worth of work on my part, and even more from Mike Burgess (an ob/gyn physician Congressman from Texas),” a clearly pleased Roe told News and Neighbor. “We know the reforms it implements, especially after the first 10 years, are going to produce a lot of savings.”

While it still awaits Senate approval, Roe expressed confidence the “Medicare Access and CHIP Reauthorization Act” will become law. It repeals a nearly 20-year-old “Sustainable Growth Rate” (SGR) model disliked by the medical community, puts Medicare on the path to outcomes-based payment reform and cost control, and even fixes a Tennessee-specific hospital funding problem in the bargain. To get buy-in from Democrats, it also reauthorizes a children’s health insurance program, CHIP, for two years, and funds essential access clinics that serve low-income and uninsured people.

The long slog to passage involved the Energy and Commerce Committee, the Ways and Means Committee, and Congress’s physicians’ conference, which is where Roe came in. He said there was a push to quickly implement payment reform – a “Merit-Based Incentive Program,” or MIPS – but that though he supports that, he pushed for a slower phase-in.

“It was a long process, and I told the other people working on this, ‘look, we’re not going to get this right just like that,” Roe said. “There’ll be some blips in this, and that’s why I wanted to phase it in. There’s just too many changes going on in medicine to throw one more at the medical community this quickly.”

Monday, the plan drew cautiously optimistic comments from Wellmont Health System Chief Financial Officer Alice Pope and Dr. Doug Springer, a Kingsport gastroenterologist who is president of the Tennessee Medical Association. Pope applauded the 10-year fix for “disproportionate share” payments for Tennessee hospitals, and also said the payment reforms that kick in starting in 2019 are part of what American health care needs long term. The DSH payments typically net Wellmont $1 to $2 million a year to offset losses associated with treating Medicaid (TennCare) patients.

The Medicare portion of the law replaces the SGR, first implemented in 1997 but overruled annually because its implementation would slash payments to doctors, with five years of 0.5 percent reimbursement rate increases to doctors until 2019, after which Medicare spending will hold flat and MIPS will adjust physician reimbursements up or down based on quality metrics.

“The pie in total is not going to increase,” Pope said. “Your slice of the pie might get bigger or smaller based on how you perform under these quality and value-based programs.”

Pope said hospitals have been operating under similar metrics for a couple of years now. Systems that can improve both their cost structure and their performance (how well patients do) can actually better their operating margins. Theoretically, she said, a continued move in that direction, and away from fee-for-service medicine with no quality measures, is good for taxpayers and should be good for patients. She said hospital systems get about 70 percent of their revenues from state and federal money.

“We understand our fiduciary duty to taxpayers, and we are completely supportive of health care reforms and payment reforms that reward high-quality, low-cost providers,” Pope said. But she was pleased at Roe’s push for a phase in, saying it would take time for providers and payors to align their reporting and expectations so reimbursements will be fair.

“The issue, which I think Phil Roe was getting to, is these reforms are very detailed. We want to learn about the data we have to report, the measurement of that data and reporting of that data back to us, and how it would impact our payment, before we are at risk,” Pope said.

Springer, who spoke to News and Neighbor in January about the speed of TennCare reform and the TMA’s push to have more say in that process, was positive this week about HR2. “My overall sense is this is going to improve things,” he said, adding that the SGR “fix” that was needed each year created too much uncertainty.

“I think in general the medical profession is on board with the alternative payment model, getting rid of fee-for-service and replacing it with value-based payments, quality reporting and meaningful use,” Springer said, referring to the backbone of the Medicare reform plan. Much of the administrative detail will be embedded in electronic medical record systems, Springer said, adding that the key will be “building the incentive payment system properly and then educating everybody on it. If quality is the main marker and goal, then everybody’s aiming at that, and that’s got to be a good thing.”

Springer was impressed with the concessions made by both parties, saying, “I think (Republican House Speaker John) Boehner won and (Minority Leader Nancy) Pelosi won, and overall it was the right thing to do. All the concessions that came out of this are things the country should be interested in funding.”

Roe said he was pleased both with the bipartisanship – “the reason we got 392 votes was doing it on a bipartisan basis” – and with how the bill was constructed deliberatively and with broad input.

“They got Republican staffers and Democratic staffers in the room,” Roe said. “They went to 25 of the medical groups and said, ‘Okay, with a reform bill, what would you like to see?’ And also we insisted that not bureaucrats but doctors’ organizations would write the criteria for the outcomes.”

The bill includes a small amount of means testing that will see higher-income seniors shoulder more responsibility for their Medicare coverage. Roe is hopeful success at this level will pave the way for further legislation to make Medicare more solvent – including further means testing.

“We’re going to transition to that to get Medicare on a sustainable footing for the future,” he said. “The next part will be hard and it will take time to get it done, but one of the biggest drivers to our long-term debt is Medicare, and until you can get Medicare costs and spending under control that’s not going to get better.

“I don’t like paying more, but I also know that I don’t like seeing a system go absolutely belly up so that my grandkids have to be burdened with debt that I left. I’m in a position now to do something about it.”