Government

Policy leaders tell AMA physicians: Medicare pay reform is a priority

Ideas in addition to damage caps are needed to pass tort reform in the Senate, Sen. Clinton told doctors at the AMA National Advocacy Conference.

By David Glendinning — Posted March 27, 2006

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Washington -- This year will be a big one for the issue of federal reimbursements to physicians, bringing with it a continuing need for doctors to meet policymakers half way, congressional and administration leaders told the American Medical Association this month.

Medicare payment reform featured heavily in addresses by Sen. Hillary Rodham Clinton (D, N.Y.) and Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, at the March 14 AMA National Advocacy Conference in Washington. Both speakers said the system for reimbursing doctors for services is unsustainable and must be repaired, with a good deal of help from physicians.

"We're at a crossroads," Dr. McClellan said. "We can continue to haggle over incremental revisions, so-called short-term fixes ... that have the effect of digging a deeper hole for the long run. Or with the continuing leadership of the AMA and with the involvement of physicians from around the country, we can shape better support for a physician-led effort to promote higher quality and lower costs."

Rep. Nathan Deal (R, Ga.), House Energy and Commerce health subcommittee chair, said that lawmakers face tough financial realities when it comes to overhauling the payment formula.

"The trouble is that the fixes are very expensive," he said.

Both Clinton and Dr. McClellan lauded the AMA for taking a big first step toward achieving comprehensive payment reform by agreeing to develop scores of Medicare quality measures for voluntary reporting, starting next year.

The measures eventually could result in a system in which the federal government pays more for what it considers better care.

The Association's move ensures that physicians are in on the ground floor of crafting a process that will see wide acceptance in the medical community, they said.

"The best way to do this is through organizations such as the AMA that represent physicians coming to agreement about what the appropriate performance measures are," Clinton said. "If the system doesn't work for doctors, it doesn't work for anybody."

The AMA must continue the momentum by sticking to the aggressive timetable for measure development on which it brokered an agreement with lawmakers late last year, Dr. McClellan said. For its part, he said, CMS will do its best to ensure that Medicare pays as fairly as possible for physician services until lawmakers can enact long-term reforms.

Dr. McClellan used the AMA conference to announce that CMS will support a recommendation from the AMA Relative Value Scale Update Committee, which counsels the agency on how to set Medicare prices, that would address a long-standing frustration for doctors.

The committee proposed that physicians receive more payment for performing medical and surgical services that require doctors to spend significant time with patients to coordinate care. Currently, Medicare does not pay for such patient interactions.

With this proposed change, however, comes the need to find price reductions in other physician services to help neutralize its effects, Dr. McClellan said. In the coming weeks, CMS will seek comments from physicians on the best way to do that.

Bridging an old divide

For Clinton, part of the AMA National Advocacy Conference was about trying to mend a rift of more than a decade.

Clinton's speech marked her first address to the Association since 1994, when she was at the tail end of trying to drum up support for the national health system reform plan that she helped draft for President Clinton's administration.

The plan eventually died in Congress after receiving a resounding rejection from physicians, health plans and other stakeholders.

"I still have the scars to show from that experience," she said.

"The debate was stymied for many, many reasons, and it is fair to say that the AMA and I did not always see eye to eye," Clinton said. "That's probably an understatement."

In her return to the Association 12 years later, Clinton weaved the Medicare payment issue into yet another call for comprehensive health system reform.

Now more than ever, she said, bold changes are needed to address increasing costs and decreasing access to care.

Physicians have come on board for some of the reforms that Clinton has pushed in recent years. A patient-safety measure enacted last year and legislation that proposes federal health information technology grants to medical professionals are two areas in which many doctors and the lawmaker agree, she said.

But a gulf in policy exists on issues such as noneconomic damage caps in medical liability cases, an AMA legislative priority Clinton dismissed as the "solution du jour."

Upon questioning from the physician audience, she acknowledged that caps should not be completely off the table but said they could not be the only solution offered.

Liability insurance reforms and confidential processes for offering compensation and apologies for medical errors should be in play as well, she said.

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