Groups Raise Concerns About Quality-of-Care Reporting
The approval by the 109th Congress of a bill (HR 6408) that would maintain the current level of Medicare reimbursements to physicians for 2007 and provide a 1.5% increase in reimbursements to physicians who agree to report data on certain quality-of-care measures "immediately raised concerns among some doctors and lawmakers who specialize in health issues," the New York Times reports. Under the bill, physicians beginning July 1, 2007, would qualify for a 1.5% bonus if they report to the government certain data on the quality of their care, such as how often they prescribe certain medications to heart attack patients or how well they manage blood pressure in patients with diabetes.
Medicare officials say the data will allow the government in the "near future ... to reward doctors who follow clinical guidelines and perhaps penalize those who flout such standards without justification," the Times reports. According to the Times, the passage of the bill has raised concerns among lawmakers from both parties, including some Republicans who "support the general idea of pay for performance."
Critics of the legislation are concerned about the idea of "federal agencies setting benchmarks for care," as well as the "feasibility of developing standards for hundreds of thousands of doctors within six months," the Times reports.
Robert Moffit, director of health policy studies at the Heritage Foundation, said, "Doctors will be financially pressured to comply with government guidelines and standards. The integrity and independence of the medical profession could be compromised."
Rep. Henry Waxman (D-Calif.) said, "I am very skeptical of pay for performance. I'm not sure we can measure quality and performance that well."
Rep. Pete Stark (D-Calif.) said doctors are supposed to provide "quality care" and should not receive extra payments for doing so. He added that federal officials "do not have the capability, the understanding, the knowledge or the training" to establish quality-of-care standards.
Rep. Nancy Johnson (R-Conn.), who has supported pay for performance, said the legislation should have included a provision that would have ensured that physicians developed the standards for measuring quality of care. "Bureaucrats must never be allowed to dictate medical practice," Johnson said.
However, Senate Finance Committee Chair Chuck Grassley (R-Iowa) said the current Medicare reimbursement system "rewards poor quality" by paying physicians for treating complications that result from their own mistakes (Pear, New York Times, 12/12).