Yes, the physician community supports a Medicare fee structure that incorporates value-based purchasing, also known as pay-for-performance or P4P. And yes, physicians can cope with a P4P phase-in if the current payment formula's sustainable growth rate (linked to the country's economic growth and the volume of physicians' services) is replaced with a factor reflecting the cost of providing care.
This double message resounds in a Nov. 28 letter (PDF file: 3 pages / 771 KB. More about PDF files.) AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., sent to CMS Administrator Mark McClellan, M.D., Ph.D. Looming: a 4.4 percent cut in Medicare physician pay that will take effect Jan. 1 unless Congress acts soon.
"The optimal outcome would be a true 'fix' to the SGR in the context of implementation of value-based purchasing using the (attached) framework" developed by the AAFP with the AMA, American College of Physicians and others and agreed to by most medical specialty societies, wrote Frank.
The framework calls for progress in 2006 in beginning to fix the SGR and requests a fee schedule update equal to the increase in the Medicare economic index (reflecting the cost of providing care). The framework incorporates pay for reporting on basic quality measures in 2007, and both pay for reporting and pay for participation in more advanced quality improvement programs in 2008 - 09. By 2010, the framework calls for P4P provisions contingent on repeal of the SGR element in the fee formula. "All physicians must be guaranteed a payment 'floor' of positive updates," the framework notes.
"Absent this possibility (of using the framework), the AAFP would favor at least a 1 percent update for 2006, with voluntary reporting. In 2007, we would support an update of at least 0.5 percent for all physicians, with another 0.5 percent for those who do report," Frank said in her letter. She added that there must be "full discussion, action and implementation" to achieve a "reasonable solution to the SGR" during 2006 - 07.
Other points Frank made:
AAFP to CMS: Fix Fee Structure While Phasing In P4P
By News Staff
- The Academy would welcome discussions about the concept of a care management fee as an adjunct to fee for service, in recognition of the value of providing the Medicare patient with a personal medical home.
- CMS should consider "pay for use" to recognize and encourage the implementation of electronic health records.
- The Academy would like to discuss with CMS the separation of evaluation and management codes from the rest of the CPT in order to address volume issues.
- The Academy wants to talk with CMS about how the Medicare Physician Voluntary Reporting Program could be improved to work effectively in small and medium-sized practices beginning in 2007. The Academy has a meeting scheduled with CMS staff to discuss the program in early December, Frank noted.
