Physicians push Congress for improved Medicare data and performance measures

The AMA and others asked a Senate panel to address issues impeding care coordination and to improve Medicare’s care delivery system.

By Charles Fiegl amednews staff — Posted July 23, 2012

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Physicians need better data and performance measurements in Medicare to improve quality of care and patient outcomes before transitioning to a new payment system, doctor organizations told a Senate committee.

Organized medicine groups testified during a July 11 Senate Finance Committee roundtable discussion on new payment and care delivery models that might replace Medicare's universal fee-for-service system. The organizations advocated for patient-centered reforms and encouraged lawmakers to support health care innovations.

The American Medical Association was one of five groups representing doctors at the hearing. AMA President-elect Ardis Dee Hoven, MD, outlined how Congress can help the Centers for Medicare & Medicaid Services abandon the current system that relies on a broken payment formula to set Medicare rates.

“Restructuring our Medicare payment and delivery system is an enormous undertaking that requires initial immediate steps that can advance us further down the road, combined with a long-term strategy that takes us to the finish line,” she said.

Dr. Hoven said Congress should require CMS to make new payment models, such as accountable care organizations and shared savings programs, available to physician practices on a rolling basis. Hard deadlines to apply for participation in new models exclude many, including small and rural practices, from participating. The agency also must provide timely feedback and data to doctors so practices can make the decisions needed to improve care, she said.

A requirement that CMS coordinate new models with private payer efforts would aid the transition, Dr. Hoven said. For instance, the Medicare agency has partnered with insurers under the comprehensive primary care initiative to test coordinated care. The model pays management fees to practices and offers incentives for lowering overall health spending.

Witnesses at the hearing also called for improvements to quality and performance measurement in Medicare. Currently, measurement is separated into silos of care, said Frank Opelka, MD, a fellow of the American College of Surgeons and a colorectal surgeon from New Orleans. But performance measurement should spread across care settings through new innovations, such as bundled payments and shared savings programs, he said.

American College of Cardiology Past President W. Douglas Weaver, MD, described the current set of measures in CMS' physician quality reporting system as crude and overly broad. The pay-for-reporting program does not distinguish a good doctor from a great doctor. He said physicians want to report measures they believe are important and developed within their specialties. (See correction)

Quality measures should address voids in health care and provide proper incentives to participate, Dr. Weaver said. Physicians also must have timely data to improve their performances and raise quality of care.

For instance, private insurers in Michigan required participation in the ACC national cardiovascular data registry to address areas with low or uneven quality of care. They required doctors to submit data and meet quarterly to discuss results. It has led to improved outcomes and drops in complication rates, he said.

“Doctors are data-driven,” Dr. Weaver said. “If you give them the infrastructure so that they have clinical data that they believe is credible, they will respond in ways to improve quality of care for patients.”

For primary care, good quality in Medicare involves managing chronic illnesses, said American Academy of Family Physicians President Glen Stream, MD. A goal for caring for diabetic patients is to prevent complications, such as helping them avoid dialysis treatments in 10 years. But the Medicare program uses short-term measures, such as blood glucose control tests and diabetic eye exams.

“We want to make sure that those are valid measures that reflect reality — the things we should be measuring and working to improve to get those eventual outcomes,” Dr. Stream said.

The health system reform law includes a requirement to implement a value-based payment modifier to the system by 2015. CMS proposed limiting the number of doctors for the program to those practicing in groups of 25 or more physicians, according to a draft regulation published July 6. However, the agency would base pay adjustments on 2013 Medicare data and PQRS performance.

Dr. Hoven said the program is a good first step, but the methodology for determining payment adjustments needs to be evaluated further. The AMA is studying the proposal and will provide comments later this year on how the rule should be finalized, she added.

Senate Finance Chair Max Baucus (D, Mont.) ended the hearing by asking physicians to submit ideas for addressing Medicare's sustainable growth rate formula. The budget mechanism used to calculate Medicare fees is set to reduce rates by an estimated 27% in 2013, according to the latest CMS figures.

“We do need some help,” Baucus said.

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How physicians say Medicare reform can start now

The American Medical Association, along with other physician organizations, has pressed lawmakers to overhaul the Medicare payment system over several years. But the AMA also has detailed ways Congress and the Centers for Medicare & Medicaid Services can take more immediate steps to transition the program to new payment models. Proposed steps outlined by the AMA include:

  • Reduce the number of measures required under physician quality reporting system measures groups from four to three.
  • Allow physicians to be considered successful under PQRS when they participate in another meaningful quality program.
  • Provide more funding for Medicare to develop and test quality measures.
  • Require Medicare to establish pay models that utilize limited bundles for physician services or episodes of care, with limited risk to doctors.
  • Examine existing laws, such as physician self-referral prohibitions, that are not compatible with new payment models.
  • Require CMS to use a performance year that is the same as the established penalty year for various initiatives.
  • Pass legislation allowing physicians and patients to contract freely for innovative pay arrangements that enhance care.

Source: “Statement of the American Medical Association before the Senate Committee on Finance,” July 11 (link)

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This article originally gave an incorrect title for W. Douglas Weaver, MD. He is past president of the American College of Cardiology. American Medical News regrets the error.

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