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R.I.P. SGR

Nine years ago, when I started developing a government relations function at Allscripts, it was a different world. No HITECH, no CMMI, no significant government attention on health IT at all, really. To set my agenda, I learned from our clients what mattered most to them.

The number one answer I consistently heard? The repeal of the Sustainable Growth Rate (SGR), which has been the means by which the CMS has had to calculate payments to physicians since 1997. It was universally – by providers and policy makers alike – reviled.

In the years since, the number of healthcare IT topics in D.C. has grown exponentially, along with the associated level of interest by legislators and regulators alike. We’ve discussed the complexities and opportunities of interoperability, debated the challenges of building a trusted patient safety structure, explained the difference between population health and public health, and more and more frequently, reviewed what quality measurement really means in health care.

But the one topic that has been our steady companion – the question raised at the end of every meeting – was “What could we do to put the SGR in the rear view mirror?” We’ve advocated to repeal the SGR for years.

More recently, even as our contacts on Capitol Hill became more confident and started to point to possible action on this in recent months, I was skeptical. We had collectively been in this optimistic place many times before, and it just seemed too good to be true.

But on April 14, 2015, the U.S. Congress finally approved legislation to repeal the SGR.  After almost 20 years of patching and extending and duct taping this legislation to avoid massive cuts in reimbursements for providers in the 45,000 physician practices across the country that we serve, they had done it.

So what does repealing the SGR mean? 

Repealing the SGR goes beyond the Meaningful Use program, beyond the Innovation Center pilots and Accountable Care Organization (ACO) programs. It is arguably the most important thing that Congress will have done at any point in recent years to move us down the path to a healthcare payment system driven by quality and outcomes improvement.

It’s not prescriptive about technology like the Meaningful Use program, and it doesn’t really push innovation limits in payment model theory. Rather, this action will raise the volume on value-driven payment models because it is about the fundamental fees going to Medicare providers.

There aren’t classes of providers left out in the same way here; it isn’t about piloting starting with a few thousand doctors either.  Instead, the legislation introduced merit-based incentive payment system (MIPS – an acronym everyone will soon be familiar with), which will lead to quality measures for almost all ambulatory providers. When you couple this change with advanced payment model adoption by both public and private sector payers, we are at a real turning point toward the data-informed, quality-driven, precise healthcare system we have been working toward for years.

Undoubtedly, the implementation of this effort is going to be monumental. There will be bumps in the road, as well as tremendously challenging work for all of us together. But ultimately, as even more providers adopt advanced health information technology and as we gather more information about which care delivers the strongest outcomes, there will be a clear beneficiary that we all care about: the patient. That feels really good.

So now, there’s just one question remaining: what is the next big healthcare IT priority for Congress? I have some ideas, but please share your thoughts in the comments below.

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About the author

Leigh Burchell directs the Policy & Government Affairs function for Allscripts, including legislative advocacy and regulatory interpretation and comment. She advocates not only for the interests of the software development community but also the company's 180,000 physician clients, 2,500 hospitals and 17,000 post-acute organizations. Burchell is also active in many industry associations, including the Electronic Health Record Association (EHRA), where she serves as Chair; the eHealth Initiative, where she sits on the Leadership Council and the Policy Steering Committee; and HIMSS, where she is Vice Chair of the HIMSS Public Policy Committee.

1 COMMENT on

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Dean Mericka says:

04/17/2015 at 3:16 pm

Leigh, thanks for the work and sharing the great news.

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