AMA Will Develop Performance Measures

The American Medical Association has reached an agreement with Congress to develop about 140 standard measures of performance for physicians covering 34 clinical areas by the end of 2006, the New York Times reports. The deal "comes as the Bush administration pushes 'pay-for-performance' arrangements with various health care providers in an effort to publicize their performance and link Medicare payment to quality," and it "mirrors efforts" from consumer groups, insurance companies and large employers to have more information on quality of care, the Times reports.

Performance measures to be developed by AMA will be intended to provide information on whether doctors follow best practices when treating patients. Federal officials gave the following examples: the proportion of diabetic patients with blood sugar and cholesterol at the recommended levels; the percentage of surgical patients who receive medications to prevent blood clots; the proportion of patients with pneumonia who receive antibiotics within a few hours of diagnosis; and the percentage of heart attack patients who receive blood pressure drugs known as beta-blockers when they arrive at the hospital.

According to the agreement with Congress, signed on Dec. 16, 2005, doctors beginning in 2007 will report to the federal government "on at least three to five quality measures per physician." The agreement adds that doctors "should receive" some additional payment to reflect the costs of collecting and reporting the data.

"By the end of 2007, physician groups will have developed performance measures to cover a majority of Medicare spending for physician services," according to the agreement.

The agreement was signed by AMA Chair Duane Cady, Sen. Chuck Grassley (R-Iowa), and Reps. Nathan Deal (R-Ga.) and Bill Thomas (R-Calif.).

AMA leaders said they agreed to develop the measures because they did not want doctors to have to fulfill a wide variety of performance measure requirements set by insurance companies, health plans and government programs. However, the presidents of seven medical specialty groups in a letter to Cady earlier this month noted that they had not been informed about the agreement and said AMA should have sought assurance that doctors would have adequate reimbursements for treating Medicare patients.

The letter added, "Many specialty societies will find it difficult if not impossible" to meet the timeline in the agreement. Frederick Blum, president of the American College of Emergency Physicians, said, "We are concerned that the push to measure quality will become just a smoke screen to cut costs and to reduce the resources devoted to health care."

Ten national doctors groups in a letter to Congress said AMA "cannot be the sole representative for the groups who are paramount to the development and implementation of quality measures."

CMS Administrator Mark McClellan said Medicare should reward doctors for "efficiency and high-quality care, not simply pay for more services." The Times reports that quality control measures have "strong support from Congress and from AARP."

AARP board member Thomas Thames said his group "support[s] moving to pay-for-performance on an aggressive timetable," adding that linking Medicare reimbursements to quality "can improve results" (Pear, New York Times, 2/21).