American College of Physicians Urges Waiting on Pay-for-Performance System in Medicare
The American College of Physicians said on Friday that Medicare's physician-reimbursement system should be converted to a pay-for-performance system only after a large, voluntary demonstration project proves the efficacy of tying physician reimbursements to performance measures, CQ HealthBeat reports (CQ HealthBeat, 3/18). The Medicare Payment Advisory Commission has advised reforming Medicare's physician-reimbursement system by tying payments to quality and earmarking 1% of Medicare funds used for hospital and doctor reimbursements to offer bonuses to providers who improve their quality of care.
To test such a system, CMS in January announced a demonstration project under which Medicare would provide bonuses to physician groups that make specific improvements in the quality of care they provide to fee-for-service beneficiaries (California Healthline, 2/11). According to CQ HealthBeat, "[k]ey congressional leaders and the Bush administration appear eager" to replace the existing physician-reimbursement system with a pay-for-performance system.
At a briefing on Friday, ACP Senior Vice President Robert Doherty said the next step toward implementing such a system should be the expansion of voluntary demonstration projects, not a mandate. He said, "We're concerned that mandates at this point will create unintended consequences and resistance" from physicians, adding that switching to pay for performance requires "a lot of work to pick the right reimbursement system and the right measures." Doherty also said that "Congress should support MedPAC's vision of performance-based improvement" but not its "budget-neutral approach," which would withhold a "portion of annual Medicare updates to physicians" and "result in across-the-board cuts in payments to practices that lack resources to invest in health information technology, leaving them further behind instead of helping to lift them up."
Doherty said existing demonstration projects do not involve enough physician practices and do not give physicians enough say in managing treatment for chronically ill patients. He added that ACP supports the creation of three- or four-year demonstration projects to test new payment methods based on clinical performance measures for 20 conditions identified by the Institute of Medicine. Doherty also urged passage of a bill (HR 747) that would require Medicare to add a payment code for use of electronic health records, electronic prescribing and computer-based clinical practice guidelines.
Meanwhile, in an interview on Thursday, Rep. Pete Stark (D-Calif.) said that a pay-for-performance system for Medicare is not likely to be implemented soon (CQ HealthBeat, 3/18).