An Age Old Question and the SGR Repeal

May 6, 2015
Turning to an age old metaphorical question and using exclusive survey data to understand if whether or not physicians are truly prepared for, or even understand, the ramifications of the SGR repeal.
If a tree falls in the forest and no one is around to hear it, does it make a sound?
It’s one of the most well-known, philosophical sayings in history. It’s been stated, restated, analyzed, and written about for decades and decades in all different kinds of mediums (books, movies, songs, parodies). We’ve had scientific papers that were dedicated to this metaphorical question. At some point, you’ve likely heard that question and tried to come up with some kind of answer. 
I got to thinking about that question and the idea that if something isn’t observed, it may not have the same outcome as something that is observed. How can people adapt to something if they don’t know it exists? For all we know, a minor shift in the tectonic plates could be happening right now and lead to a devastating earthquake in a few hours. Yet, if you don’t know, you can’t prepare. 
Or less dramatically, can a group of people prepare for provisions that are included in a law that affects them if those people have no idea the provisions exist? Specifically, I’m talking about the repeal of the Sustainable Growth Rate (SGR).
The SGR is well known among doctors because it’s the formula for how they’ll be reimbursed under Medicare. The repeal, which instituted a 0.5-percent payment update for the next five years for physicians, ended the nearly 20 years of temporary “doc pay fixes” that kept this formula from going off the cliff. 
The repeal is much more than that though. It includes a lot of provisions, many of which are “game-changing,” for health IT leaders and those involved with health IT implementations, according to Blair Childs, senior vice president of public affairs at Premier Inc.  
Most prominently, it replaces physicians’ mandatory participation in the Value-Based Payment Program under Medicare (for all physicians participating in Medicare) with a new Merit-based Incentive Payment System, or “MIPS.” The MIPS program would reimburse under four key areas: quality, resource use, clinical practice improvement (including care coordination and improvement activities), and the meaningful use of certified EHR (electronic health record) technology. In of itself, MIPS is a huge shift towards value-based care. 
Moreover, the law promotes and defines interoperability, requires metrics to measure interoperability, requires a report to Congress on the progress of interoperability by the last day of 2018, requires attestation that vendors/providers are not blocking data, and more. It also consolidates reporting requirements for meaningful use, the physician quality reporting system (PQRS), and the value modifier. It sunsets penalties for meaningful use by 2019 as well.
That’s a lot! To be frank, that is only part of it. The law includes a lot of provisions that obviously don’t have a major impact on health IT. It’s a lot to take in. 
Yet, those aforementioned elements of the law have seemingly gone unnoticed by the very people it would affect most. We recently conducted a survey of 102 physicians, through the doctor-based social network QuantiaMD, on the SGR repeal and those aforementioned parts to it. What we found was that more than 70 percent of doctors were not aware of the meaningful use provision, slightly less than half were aware of the MIPS provision, and 44 percent were not at all familiar with the different elements of the law. Only three people out of the 102 said they had become very familiarized with the different elements of the law and 64 percent said they were not at all well-versed in the health IT implications of the law. 
The survey was pretty telling. Despite the fact that this SGR repeal, called the Medicare Access and CHIP Reauthorization Act, has a huge impact on physicians, most of them don’t even know that much about it. 
That goes back to my original question: How can people adapt to something if they don’t know it exists? In the case of the SGR repeal, hopefully, we won’t have to find out. Unlike the tectonic plates, the impact won’t be nearly instantaneous. It will take a few years to get in place. By then, physicians may have found the time to prepare for the changes drawn out in the SGR repeal. 
Let’s hope so. The tree falls, whether or not you hear it. 
Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna

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