Changes to Medicare Physician Payment Formula Possible, McClellan Says
Lawmakers might enact changes to the Medicare physician payment formula in time to reverse payment rate reductions scheduled to take effect in January 2006, CMS Administrator Mark McClellan said Monday while distributing a "quality-improvement roadmap" for Medicare, The Hill reports. At a press briefing, McClellan said he has been working with lawmakers and physician organizations to develop proposals to prevent the payment cut and to repeal the formula currently used to set physician payment rates. One change that "can be made in time to prevent next year's cut" is instituting a system in which physicians are rewarded for providing quality care, McClellan said.
The quality-improvement roadmap he distributed Monday included several pay-for-performance proposals that "resemble those espoused" by House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.) and Senate Finance Committee Chair Chuck Grassley (R-Iowa), The Hill reports.
"What I don't think is going to happen this year is just adding" funds to Medicare to increase physician payments, as has been done in years past, McClellan said. He added that if Congress does not enact changes to the Medicare physician payment system itself, CMS can act on its own to lessen the impact of the scheduled payment cut and promote higher-quality care. "There's plenty we can do without legislation," he said (Young, The Hill, 7/26).
In addition to the pay-for-performance proposal, the roadmap McClellan distributed included four other quality-improvement strategies for Medicare that CMS will coordinate. One strategy involves creating and strengthening partnerships within CMS, HHS, other federal and state agencies and private-sector providers. The roadmap says the partnerships seek "large improvements in specific areas where large quality gaps have been demonstrated and stakeholders have identified specific steps to improve performance."
Another strategy outlined by McClellan focuses on how to measure quality, saying that 17 existing hospital quality standards developed by several organizations will be expanded to address such issues as patient satisfaction and post-operative care.
The third strategy involves publishing performance data and developing new payment methods through Medicare Quality Improvement Organizations in each state, while the fourth seeks to improve patients' access to new medical technologies and improve measurements of the technologies' effectiveness. McClellan also said Medicare is "definitely on track" to use data from the new prescription drug benefit to measure the effectiveness of drugs and their distribution through the benefit. "By 2007, you'll start seeing analyses done and reports coming out," he added (CQ HealthBeat , 7/25).
In related news, Republican lawmakers this week are joining the Bush administration's efforts to promote the new Medicare prescription drug benefit. According to Roll Call, a Republican Conference event on Thursday will include more than 100 representatives of trade associations and the business community in an effort to focus attention on the upcoming enrollment phase for the new benefit. "This is going to be a concerted effort by us to engage the business community to make seniors aware of this benefit that's available to them," conference spokesperson Sean Spicer said.
Ron Bonjean, a spokesperson for House Speaker Dennis Hastert (R-Ill.), said, "Our intention is to make a big effort to get our members to push for seniors to get involved in the prescription drug program. ... Seniors are always thinking about this issue, and we need to show them that we're on top of it" (Pershing, Roll Call, 7/26).
Meanwhile, a Social Security Administration official has expressed concern that the asset test form for the drug benefit for low-income beneficiaries might be difficult for some beneficiaries to complete. According to CQ HealthBeat, many low-income seniors are cognitively impaired and the form is too difficult for many to complete on their own, Bea Disman, chair of SSA's Medicare Task Force, said.
Although the application is only four pages long and has 11 questions, many beneficiaries are having difficulty with one question about life insurance policies, Disman said, noting that SSA officials are working to simplify that part of the form. She also said that SSA is working to train people willing to assist beneficiaries in filling out the form. Disman would not say how many of the 10 million forms mailed out so far have been completed, noting that it is too soon in the application process (CQ HealthBeat , 7/25).
Additional information on the Medicare drug benefit is available online.