The "doc fix" solution now pending in front of the Senate, or
that will be when they return from recess, is hampered a little bit by the fact that this hiccup in it being railroaded through Congress means everyone has a little bit more time to consider everything that's in it. That includes problematic abortion language and a shorter extension of the Children's Health Insurance Program than Democrats wanted. But it also includes questions about the key function of this proposal—replacing how doctors seeing Medicare patients
get paid.
[T]he new way Medicare is going to pay doctors forces the government to do something it's not very good at: measure how good—or bad—doctors are at their jobs. Worse, the new bill doesn't say much about how the government is meant to accomplish this task.
"I'm very skeptical of this," says Robert Berenson, a fellow at the Urban Institute whose research focuses on Medicare policy. "It's really absurd that we don't have any measures for most doctors that can place a value on their performance."
The sentiment is the same on the right.
"The existing quality measures aren't relevant to what [doctors] do in their everyday practice," says John O'Shea, a senior fellow at the Heritage Foundation who previously advised Energy and Commerce Chairman Fred Upton (R-MI) on health policy. "They don't result in better patient care. I think we're going to need better quality measures."
The administration has been working hard to reinforce quality over quantity in Medicare and our healthcare system overall, and this is one more step toward doing that. This fix creates two programs doctors can choose from to structure their payments: the Merit-Based Incentive Payment System (MIPS) which gives individual doctors quality of care scores that add up to higher reimbursements; and an Alternative Payment Model, which allows doctors to group together and take lump sums of money for treating a group of patients. If they keep costs down, there's surplus in that lump sum payment that they can divvy up.
The difficulty right now is that this legislation doesn't spell out at all either what quality metrics the government might be using in the MIPS model, or what one of those alternative models would look like. To an extent, it's doctors trading the uncertainty of the annual trauma of temporary "doc fix" bills to the uncertainty of how they're going to be graded for providing care. That's all going to be up to how the regulators in this and the next administration decide it should work, since these new payment systems will start in 2019. At the moment, it doesn't look like that uncertainty will be enough for the providers to bail on the bill, but it could definitely slow down its momentum.