Physician advocates in D.C. eager to shift focus to quality

With the “doc fix” behind them, cardiology's advocates are ready to move onto other important issues. “Now we can really start talking about how we implement rewarding quality of care and switching from volume to quality,” said Peter Duffy, MD.

Duffy, co-chair of the Advocacy Committee for the Society for Cardiovascular Angiography and Interventions (SCAI) and director of quality for the Cardiovascular Service Line at FirstHealth of the Carolinas Reid Heart Institute/Moore Regional Hospital in Pinehurst, N.C., and M. Eugene Sherman, MD, chair of the American College of Cardiology’s (ACC) Advocacy Steering Committee and a physician at the Aurora Medical Association in Colorado, said their organizations have been lobbying against the flawed sustainable growth rate (SGR) formula for nearly two decades. The SGR tied Medicare physician fees to the overall national economy. In 2003, Congress began approving annual patches to prevent cuts from taking place; this year’s proposed cut was 21.1 percent.

The House approved a bipartisan bill to repeal the SGR in late March and the Senate followed suit on April 14. President Obama has said he would sign the bill into law.

Congress recognized that the current model had created an impediment in efforts to shift from a fee-for-service to a value-based system, Duffy and Sherman said. H.R. 2, or the Medicare Access and CHIP Reauthorization Act of 2015, replaces the SGR with a payment formula that guarantees a 0.5 percent annual increase beginning in July that will continue through 2019. It also provides a merit-based payment system and allows for other payment models to be developed.

“Part of the value equation is price,” Sherman said. “We have to make the system transition and we can’t do that by underpaying doctors” during the process. He praised the House and Senate leadership for getting both parties to compromise.

“Nobody was 100 percent happy with this bill,” Sherman said. “Everybody knows you give a little and you lose a little.” The leadership, for instances, kept the list of amendments to three and steered membership through the voting. “They got it done.”

Eliminating the SGR removes the uncertainty that hounded physicians and healthcare systems, Duffy said. The possibility of a cut in funding made it difficult to project budgets, plan for capital improvements and expansions and retain talented staff, all of which impacted patient care.  

“Patients really benefit from a sound financial structure, and this goes a long way toward providing us with that,” Duffy said.

With the SGR no longer a distraction, the advocacy groups and decision-makers in Washington, D.C., can focus on patient-centered care, collaborating to improve care and reduce cost. “We were the first to come out with appropriate use criteria, which dramatically reduced imaging cost in the United States,” Sherman pointed out. “We want to work with Congress on these issues.”

Duffy identified four key themes going forward: Resource utilization, patient-centered care, clinically defined outcomes and appropriate and necessary care. “We are in a transition phase right now where we have process measures in place and even to some degree outcomes measures in place but we don’t have the total package put together yet.”

They urged their membership to remain involved and build on the momentum. Sherman cited interest in Congress in resources such as the ACC’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons’ Transcatheter Cardiovascular Therapeutics registry. Duffy said physicians, as advocates for their patients, need to help Congress and policy makers understand their roles and challenges.    

“We as physicians have to take the lead,” Duffy said, “because we are not only down there in the trenches on a daily basis but we also have the best understanding by having to deal with patients on a one-to-one basis of what their needs are and how to best serve them.”

For more on cardiovascular advocacy initiatives, read “Physicians as Advocates: On Call in D.C.