Rays of hope needed in Medicare muddle

Amid the confusion and anxiety over the physician payment cuts mandated by Medicare's fatally flawed sustainable growth rate, one ray of hope emerged that has real potential for the future.

Don't get me wrong. The jury is still out, as of this writing, and I cannot say with certainty that the draconian 4.4% cut in the sustainable growth rate will be rejected and the federal government will continue in 2006 to use the 2005 rate.

To paraphrase Winston Churchill, though, I believe we may not be at the beginning of the end to our sustainable growth rate problems, but we are at the end of the beginning.

By that I mean real progress has been made, clear dialogue has begun and a pattern of action is emerging from the haze of skirmishes.

This is especially true in the area of federally imposed quality standards at the heart of the pay-for-performance issue.

As you might know, the Dept. of Health and Human Services' Centers for Medicare & Medicaid Services had proposed implementing a form of pay-for-performance -- the Physician Voluntary Reporting Program -- as a precursor to a full-blown pay-for-performance program.

In our discussions with CMS Administrator Mark McClellan, MD, PhD, we were able to convince him to modify his program, to allow us and others to offer alternative ideas.

Rep. William Thomas (R, Calif.), chair of the House Ways and Means Committee, made it crystal clear to me in December 2005, when we discussed the SGR matter, that Congress and CMS want very much to include a pay-for-performance mechanism with future Medicare reimbursement plans.

He did not give me a timetable, but his words tell me there will be a great deal of activity in the coming months.

Meanwhile, great appreciation is due to you and your colleagues, and to your patients, for the wholehearted support we were able to mobilize in making America aware of the catastrophic consequences of the scheduled 4.4% Medicare payment cuts.

Congress received 534,000 contacts on the matter -- about 49,000 from physicians and 485,000 from patients.

That level of citizen outcry supplemented by an all-out media blitz of advertising, news stories and opinion page editorials had an effect.

It convinced Washington to avert the cut and, if indications prove correct, at least freeze the SGR payment schedule for another year. Both parties and both houses of Congress agreed with us.

That is no victory.

The true victory will come when a positive, progressive, appropriate payment system is designed and enacted.

One aspect of that is evidence-based performance measures as a basis for any fair and equitable payment system.

The AMA has doubled its staff developing performance measures within the Physician Consortium for Performance Improvement, developing measures across an ever-broadening spectrum of medical specialties.

The 16 performance measures recommended in the CMS voluntary reporting program need to be assigned CPT-2 codes rather than the present G-codes CMS has awarded them. This would reduce the irritation and confusion physicians now face using G-codes instead of the usual CPT codes when billing.

That would be another ray of hope.

Another source of hope is the prospect for making a gradual, rather than a wrenching, conversion to any new payment system. Some even hope to convince lawmakers of the wisdom of a truly rational, index-based payment mechanism similar to those that have gradually, even voluntarily, emerged in some other quarters of the U.S. health care system.

As I said, much work needs to be done, and we've rolled up our sleeves.

The AMA and key members of Congress and the Bush administration need to work together to develop a new payment mechanism that truly recognizes physician expenses in delivering quality care to patients. It will take an honest effort on everyone's part.

The AMA and the consortium have laid much useful groundwork.

Our task is to work diligently to translate that work into law.