AAFP to Congress: Three-pronged Approach Could Help Resolve Medicare Woes
By News Staff
3/4/2005
Medicare could ensure patients’ access to care and restrain costs. How? In three ways:
- replace the sustainable growth rate formula for determining physician reimbursement,
- implement pay-for-performance rewards and
- establish a care management fee that recognizes primary care physicians’ expertise.
That was the three-pronged message the Academy sent the U.S. House Ways and Means Health Subcommittee Feb. 23 in a written statement. It will be part of the materials the subcommittee considers pertinent to its Feb. 10 hearing on physicians’ Medicare reimbursement.
If implemented, the Academy’s approach would ensure access to health by providing a financial foundation for physicians who accept Medicare patients while helping avoid duplication, medical errors and other costly elements in the current system.
If implemented, the Academy’s approach would ensure access to health by providing a financial foundation for physicians who accept Medicare patients while helping avoid duplication, medical errors and other costly elements in the current system.
This story first appeared in the March 4, 2005, AAFP Direct.
Under the current SGR formula, physician payments would plummet by as much as 30 percent while providers’ costs would rise by an estimated 20 percent over the next seven years.
“Such unrelenting decreases will make it impossible for many more family physicians to accept new Medicare patients,” the Academy statement said.
The AAFP called for eliminating the SGR; adjusting the payment updates to the medical economic index, used to estimate the cost of providing care; and then deducting a productivity factor.
Changing the SGR formula is tied to implementing pay-for-performance programs, said Kevin Burke, director of the AAFP Government Relations Division. Congress probably won’t alter Medicare reimbursement without simultaneously holding physicians accountable for the care they provide.
The Academy supports pay for performance if it:
“Such unrelenting decreases will make it impossible for many more family physicians to accept new Medicare patients,” the Academy statement said.
The AAFP called for eliminating the SGR; adjusting the payment updates to the medical economic index, used to estimate the cost of providing care; and then deducting a productivity factor.
Changing the SGR formula is tied to implementing pay-for-performance programs, said Kevin Burke, director of the AAFP Government Relations Division. Congress probably won’t alter Medicare reimbursement without simultaneously holding physicians accountable for the care they provide.
The Academy supports pay for performance if it:
- is implemented within the context of a positive annual update for reimbursement;
- rewards physicians’ use of measures identified by collaborative efforts of the AAFP, American College of Physicians, Agency for Healthcare Research and Quality, and other medical specialty societies; and
- doesn’t force physicians to compete for insufficient funding.
Equally important, Medicare should reward cost-effective care coordination and integration by reimbursing for care management, according to the AAFP statement. Noting the current system “rewards physicians for ordering tests and performing procedures,” the Academy said Congress should authorize a combination of fee-for-service reimbursement with a per-beneficiary, per-month stipend for care management.
“Congress and CMS must be willing to adequately reimburse primary care functions,” the AAFP told the subcommittee. “Without the necessary resources to allow physicians to design their clinical workflow to deliver quality outcomes, Medicare beneficiaries will continue to experience fragmented and ineffective care.”
AAFP, in opposing the SGR, joins a host of other groups. Among them: the Association of American Medical Colleges, AMA, the American College of Physicians and the Medicare Payment Advisory Commission.
The AAFP statement is here. To read MedPAC’s Feb. 10 testimony, go to http://www.medpac.gov/publications/
congressional_testimony/021005_WM_testimony.pdf (More information on using PDF files), and to read ACP’s testimony, go to http://www.acponline.org/advocacy/?hp and click on “ACP Recommendations for Improving the Dysfunctional Payment System.” A previous AAMC position is at http://www.aamc.org/advocacy/library/teachphys/phys0018.htm, and earlier AMA testimony is at http://www.ama-assn.org/ama1/pub/upload/mm/399/mpu_testimony.pdf (More information on using PDF files.).
“Congress and CMS must be willing to adequately reimburse primary care functions,” the AAFP told the subcommittee. “Without the necessary resources to allow physicians to design their clinical workflow to deliver quality outcomes, Medicare beneficiaries will continue to experience fragmented and ineffective care.”
AAFP, in opposing the SGR, joins a host of other groups. Among them: the Association of American Medical Colleges, AMA, the American College of Physicians and the Medicare Payment Advisory Commission.
The AAFP statement is here. To read MedPAC’s Feb. 10 testimony, go to http://www.medpac.gov/publications/
congressional_testimony/021005_WM_testimony.pdf (More information on using PDF files), and to read ACP’s testimony, go to http://www.acponline.org/advocacy/?hp and click on “ACP Recommendations for Improving the Dysfunctional Payment System.” A previous AAMC position is at http://www.aamc.org/advocacy/library/teachphys/phys0018.htm, and earlier AMA testimony is at http://www.ama-assn.org/ama1/pub/upload/mm/399/mpu_testimony.pdf (More information on using PDF files.).
