Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Federal update: Health care reform and the Quality Payment Program

The U.S. Senate’s efforts to repeal and replace the Affordable Care Act with the Better Care Reconciliation Act (BCRA) of 2017 were derailed earlier this week when the Senate failed to garner enough votes to move forward with debate on the amended proposal.

Senate Majority Leader Mitch McConnell announced Tuesday night that the vote to begin the repeal and replace debate will occur next week at President Trump’s request, but the situation in the Senate remains fluid. While both the BCRA and repeal-only bills would reduce the federal deficit significantly—by as much as $420 billion by 2026—the Congressional Budget Office estimates that 22 million Americans would lose health insurance coverage under the Senate’s latest proposal. (You can read the full CBO reports here.)

The Wisconsin Medical Society continues to advocate for changes that adhere to its health care reform principles, which were developed earlier this year and call for the following to be addressed in any health care reform proposal:

  • Those who are currently insured should not lose coverage, and coverage should be affordable.
  • The following patient protections currently included in the ACA should be maintained:
    • Guaranteed coverage for pre-existing conditions, including mental and behavioral health.
    • The ability for children to remain on their parent’s insurance plans until age 26.
    • The ban on lifetime caps for coverage.
  • Adequate Medicaid funding is essential.
  • Any reform to Medicaid and Medicare should ensure the programs are viable, effective mechanisms to provide coverage to the most vulnerable patients: low-income individuals, seniors and the disabled.

Quality Payment Program
Society staff is also reviewing the revised guidelines surrounding the Quality Payment Program (QPP) as created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Proposed changes to the QPP include creating virtual groups as an option for participation in the QPP, increasing the low-volume provider threshold, revised certification requirements regarding electronic health records and changes to both Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APMs) scoring methodologies (e.g., bonus payments for treating complex patients) in order to encourage participation. The Society will submit comments on the proposed rule in August. (Click here to read more in the June 22 Medigram.)

If you have questions about either of these issues, contact Society staff Lisa Davidson or H.J. Waukau.

Back to July 20, 2017 Medigram