Doctors ask Congress for role in reforming Medicare programs

Lawmakers and organized medicine discuss ways physicians can develop payment alternatives that reward quality care.

By Charles Fiegl amednews staff — Posted Aug. 20, 2012

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Congress should look toward quality programs developed by physicians when drafting proposals to overhaul Medicare’s payment system, physician organizations and lawmakers said during a recent House hearing.

Improving Medicare pay is not limited to repealing the sustainable growth rate formula, said Rep. Wally Herger (R, Calif.), chair of the House Ways and Means health subcommittee. During a July 24 hearing, the panel sought ideas for developing new pay models that create incentives for high-quality care. With low rates of participation in Medicare’s quality initiatives, lawmakers said they wanted doctors to lead new efforts for measuring quality and efficiency.

“Many are concerned about the lack of alignment among Medicare’s current incentive programs to enhance quality, such as e-prescribing, meaningful use of electronic health records and the so-called value-based modifier,” Herger said. “Such programs were generally not developed nor led by the physician community.”

Physician organizations testifying during the hearing shared Herger’s concerns of the “top-down, government-centered” approach to paying for quality in Medicare. Congress should improve Medicare’s quality improvement programs administered by the Centers for Medicare & Medicaid Services, said David L. Bronson, MD, president of the American College of Physicians.

“The measures, incentives and reporting requirements for these programs should be harmonized to the greatest extent possible,” Dr. Bronson said. “CMS also needs to do a better job providing timely performance data to physicians participating in these programs.”

The quality programs could be aligned with requirements from a physician specialty board’s maintenance-of-certification process, Dr. Bronson said. For instance, the American Board of Internal Medicine certification process includes quality measures and reporting.

The American Medical Association also has called on CMS to align its quality initiatives. The AMA, along with state and specialty physician societies, sent the agency a March 28 letter urging the program to coordinate reporting requirements and incentives. CMS has indicated some willingness to get its initiatives in sync with one another. For instance, officials have proposed aligning criteria for reporting physician quality reporting system measures through an EHR with the clinical quality measure component of the EHR bonus program in 2013.

Further reforms to the broken payment system is a top priority for the American Gastroenterological Assn., said Michael Weinstein, MD, chair of the AGA Digestive Health Outcomes Registry Executive Management Board. The association has taken steps to improve the system by creating a registry aimed at patient health outcomes and cost-effectiveness of digestive care. For example, the registry can help a physician follow guidelines to manage patients with inflammatory bowel disease.

The group also is working to support alternative payment models to fee for service as more private insurers have moved to population-based payments. Gastroenterologists are working to develop components of a bundled payment for colonoscopies.

“This will help physicians to demonstrate value and negotiate for the services they provide to a population of patients,” Dr. Weinstein said.

The current fee-for-service system is appropriate for some health care services, but it is not the most efficient system for many services and procedures, said Peter J. Mandell, MD, chair of the American Academy of Orthopaedic Surgeons Council on Advocacy. The future Medicare system should include multiple payment models, including systems utilizing capitation, tiers, episodes of care and other options.

Risk adjustment also is essential to account for issues outside of the physician’s control, Dr. Mandell said. For instance, doctors would be punished when an alternative model does not consider the costs of treating complex cases.

“The patient must be the focal point of any initiative, and therefore the system must not create incentives to treat healthier patients and limit access to sicker ones,” he said.

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