Medicare Physician Payment Innovation Act of 2013
Latest action (6 Feb 2013): Introduced
What this bill does
H.R. 574, the Medicare Physician Payment Innovation Act of 2013, proposes to replace the current system for determining Medicare physician payments with a new structure. The bill would eliminate the sustainable growth rate system and set physician payment rates at a 0.0% update for 2014. Starting in 2015, it would establish separate payment rates and annual updates for primary care services and other physician services, with different rates intended through 2018.
The bill aims to encourage the testing and adoption of new ways to deliver and pay for healthcare. It directs the Secretary of Health and Human Services to expand pilot programs for innovative payment models in at least three geographic areas and to include the cost of implementing these models for physicians in their evaluation. The Comptroller General would study these evaluations and report to Congress. The Secretary would also inform healthcare providers about transitioning to models focused on improving care coordination, quality, and efficiency.
This bill was introduced in the House of Representatives in February 2013 and has not progressed beyond that stage. If enacted, it would change how Medicare pays physicians and encourage the development of alternative healthcare delivery and payment models. The bill also specifies further changes to payment rate updates for physicians, freezing them for 2019, establishing specific negative updates from 2020-2023 with exemptions for certain providers, and then freezing them again from 2024 onward.
Plain-English summary generated by Bill100 AI from the official record. Always verify against the source below.
Official summary
Medicare Physician Payment Innovation Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise requirements for payments for physician's services to eliminate the sustainable growth rate system from the formula for determination of the fee schedules for such services.
Sets at 0.0 the 2014 update to the single conversion factor in such formula.
Establishes updates for separate primary care and other service categories beginning January 1, 2015, as well as separate conversion factors and separate updates through 2018 for each service category.
Directs the Secretary, through the Center for Medicare and Medicaid Innovation, to: (1) expand testing of each innovative payment and service delivery model in at least three geographic regions; and (2) include analysis of average implementation costs, per physician, in evaluations of models in phase 1 testing.
Specifies as such a model, subject to testing, payment for outpatient therapy services and speech language pathology services on the basis of a treatment session, an episode of care, or other bundled payment methodology as a model to be tested during phase 1 testing.
Directs the Comptroller General to study the evaluations of each model tested.
Directs the Secretary to release to the public a comprehensive list of such health care delivery models identified as likely to: (1) reduce spending without reducing quality of care, or (2) improve the quality of patient care without increasing spending.
Requires the Secretary to inform physicians, nurse practitioners, group practices, and institutions employing Medicare part B (Supplementary Medical Insurance) providers on how best to transition to alternative health care delivery and payment models aimed at improving the coordination, quality, and efficiency of health care.
Common questions
- What does H.R. 574 do?
- H.R. 574, the Medicare Physician Payment Innovation Act of 2013, proposes to replace the current system for determining Medicare physician payments with a new structure. The bill would eliminate the sustainable growth rate system and set physician payment rates at a 0.0% update for 2014. Starting in 2015, it would establish separate payment rates and annual updates for primary care services and other physician services, with different rates intended through 2018. The bill aims to encourage the testing and adoption of new ways to deliver and pay for healthcare. It directs the Secretary of Health and Human Services to expand pilot programs for innovative payment models in at least three geographic areas and to include the cost of implementing these models for physicians in their evaluation. The Comptroller General would study these evaluations and report to Congress. The Secretary would also inform healthcare providers about transitioning to models focused on improving care coordination, quality, and efficiency. This bill was introduced in the House of Representatives in February 2013 and has not progressed beyond that stage. If enacted, it would change how Medicare pays physicians and encourage the development of alternative healthcare delivery and payment models. The bill also specifies further changes to payment rate updates for physicians, freezing them for 2019, establishing specific negative updates from 2020-2023 with exemptions for certain providers, and then freezing them again from 2024 onward.
- Has H.R. 574 become law?
- Not yet. As of 6 Feb 2013, H.R. 574 is introduced.
- Who sponsored H.R. 574?
- H.R. 574 was sponsored by Rep. Allyson Schwartz [D-PA13, 2005-2014] (Democrat-PA), with 40 cosponsors.
- What's the latest action on H.R. 574?
- Introduced (6 Feb 2013).
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