The legislation, the Health Technology to Enhance Quality Act, or Health TEQ Act, would establish an Office of the National Coordinator of Health Information Technology; promote a national, interoperable health information technology infrastructure; and establish pilot tests on pay-for-performance programs. Sens. Bill Frist, R-Tenn., and Hillary Clinton, D-N.Y., announced the bill June 16.
The Health TEQ Act contains "farsighted provisions," said AAFP Board Chair Michael Fleming, M.D., of Shreveport, La., in a letter of support to Frist and Clinton. "These provisions appropriately focus on developing the network necessary to support the exchange of a patient's health information in a way that assures privacy and flexibility," Fleming wrote.
In addition, the Academy supports the Health TEQ Act's call for developing health care quality standards. Those standards, said Fleming, should be reviewed and endorsed by an independent organization such as the National Quality Forum, which has expertise in the health care system.
Fleming did note the Academy had some reservations about other provisions of the bill. The AAFP supports the bill's call for pilot tests on the effectiveness of using value-based purchasing -- also known as pay-for-performance -- for Medicare payment. After two years of testing, HHS would be allowed to make the value-based purchasing program a national one.
"However," said Fleming, "value-based purchasing depends on the widespread use of interoperable health information technology everywhere in the health care system, including physicians' offices. Given the limited dispersion of this technology at the present time, it may be unrealistic to expect that, in two years, it will be feasible to implement any technology-based purchasing program."
Even more important, pay-for-performance programs should not be budget-neutral, according to Fleming’s letter. The pilots and any ensuing payment system should reward physicians for high-quality care rather than provide "incentives" to some by withholding a percentage of all physicians' payment.
"If the value-based purchasing does not involve added funding, then physicians may find it difficult, if not impossible financially, to participate," said Fleming. "This may not be a formula for improved health care."
