Elderly patients may lose access to health care if pay-for-performance legislation introduced June 30 passes unchanged, according to AAFP President Mary Frank, M.D., of Mill Valley, Calif.
"We are gravely disappointed," she said of the bill, dubbed the Medicare Value Purchasing Act. "It does not do anything to give immediate relief from our Medicare cuts for the coming year and that's not tolerable."
The legislation would implement value-based purchasing -- a synonym for pay-for-performance -- without addressing an expected 4.3 percent reduction in Medicare payments, which will go into effect Jan. 1 if Congress does not prevent it. The bill's chief sponsors are Sens. Charles Grassley, R-Iowa, chair of the Senate Finance Committee, and Max Baucus, D-Mont., ranking Democrat on the Senate Finance Committee.
Instead, the bill's pay-for-performance plan would withhold an additional 2 percent of Medicare payment until physicians reported meeting specific care standards to CMS. Moreover, the bill does not contain provisions for ensuring physicians can afford the information technology or additional office staff time needed for compliance.
Therein lies the problem, according to Frank.
"These new requirements on physicians will mean they face lower payments and additional costs," she said in a formal statement responding to the bill. "This is not a formula for improving health care quality.
"In a nutshell, doctors continue to face declining reimbursements for Medicare patients. The bill will probably increase doctors' costs in order to meet and report specific care standards, but it doesn't help them obtain the technology to do so. If doctors don't have the technology to participate in the reporting system, their reimbursement will be cut even further, which will hinder their ability to ever be able to afford the technology."
It's a vicious cycle that ultimately will force family physicians to curtail the number of Medicare patients they see, she added.
Other legislation addressing the issues:
Pay-for-Performance Bill Falls Short, Says Academy
By Leslie Champlin
7/6/2005
- Better Healthcare Through Information Technology Act, introduced July 1 by Sens. Michael Enzi, R-Wyo., and Edward Kennedy, D-Mass., to establish a public-private partnership on national technical standards and provide grants to physicians for buying or upgrading electronic health record systems.
- Health Technology to Enhance Quality Act, or Health TEQ Act (at the Library of Congress' THOMAS Web site, type "S. 1262" in the search bar after selecting "Enter bill number"), introduced June 17 by Sens. Bill Frist, R-Tenn., and Hillary Clinton, D-N.Y., to develop an IT network, establish health quality standards and create pilot tests of pay-for-performance initiatives. The Academy has offered qualified support for the proposal.
- Health Information Technology Act, or Health-Tech Act (at THOMAS, search for "S. 1227"), introduced June 13 by Sens. Debbie Stabenow, D-Mich., and Olympia Snowe, R-Maine, would provide grants of up to $15,000, tax incentives and restructured Medicare payments to physicians who buy, implement or improve EHR systems.
- Preserving Patient Access to Physicians Act (at THOMAS, search for "S. 1081"), introduced May 19 by Sens. Jon Kyl, R-Ariz., and Debbie Stabenow, D-Mich., would, according to an AAFP statement, provide a Medicare payment increase of at least 2.7 percent in 2006 and an updated payment of about 2.6 percent in 2007.
"The Academy supports pay-for-performance," said Frank. "But we don’t want it to be a take-away. We want the base rate and the incentive added as a bonus."
