The AAFP supports a well-planned and thoughtfully implemented Medicare pay-for-performance system, but it does not support CMS' recently unveiled voluntary reporting system, widely considered to be a "warm-up" to P4P implementation.
AAFP Statement to Congress
Restructure Medicare Payment, But Do It Right
By News Staff
11/21/2005
That was the gist of a Nov. 17 statement, "Medicare Physician Payment: How to Build a More Efficient Payment System," (PDF file: 9 pages / 995 KB. More about PDFs.) submitted by the Academy to the House Energy and Commerce Health Subcommittee and a Nov. 15 letter (PDF file: 1 page / 111 KB. More about PDFs.) sent by AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., to CMS Administrator Mark McClellan, M.D., Ph.D.
The Nov. 17 statement called on Congress to restructure Medicare by
The Nov. 17 statement called on Congress to restructure Medicare by
- repealing the sustainable growth rate formula that determines Medicare physician payment and that currently calls for a 4.4 percent reduction effective in January;
- ensuring that pay-for-performance programs occur in the context of positive payment updates;
- paying for care coordination for Medicare beneficiaries;
- basing pay-for-performance incentives on process, structural and outcomes measures; and
- linking payment to health care quality and efficiency.
"Moving the Medicare program in this direction cannot be accomplished in an environment of declining physician payment," the AAFP statement says. "Congress must take steps to stabilize physician payment through positive updates."
Unfortunately, Congress does not appear to be following that path. Current budget reconciliation legislation fails to change the SGR-based formula that is the basis for Medicare payment to physicians. Moreover, Congress might not override the 4.4 percent Medicare payment reduction that will occur in January as a result of use of the SGR.
In addition, the recent announcement of CMS' Physician Voluntary Reporting Program threatens to undermine progress made in structuring a viable pay-for-performance system, said Frank in her letter to McClellan.
"A disproportionate burden of this program falls on the shoulders of primary care physicians, whose services have been long undervalued by Medicare," Frank wrote. "Asking physicians to invest in new reporting systems, whether in a paper-based office or one using electronic health records, in an environment of a potential 4.4 percent payment cut is unreasonable."
Moreover, CMS "appears to have largely ignored" the work of the AAFP and other organizations in the Ambulatory care Quality Alliance, said Frank. High-level CMS officials were working with the alliance to develop a "starter set" of performance measures that would form the foundation of a physician reporting system.
Instead, the PVRP includes reporting measures that could apply to every Medicare patient in a family physician's practice. In addition, the program simply alters measures used by hospitals and applies them to physician offices.
The AAFP statement echoed Frank's position. "The (quality performance) measures identified have been randomly selected; do not lend themselves well to electronic reporting; may, in fact, require medical record abstraction; have not been vetted through a consensus-development process that is essential to acceptance and success; and are not all based in scientific evidence," the AAFP statement notes.
Thus, though the Academy supports pay-for-performance, "the AAFP must oppose the CMS voluntary reporting initiative, as it undermines the organized, incremental transition to the pay-for-performance methodology and is slated for implementation just as the 4.4 percent reduction of Medicare payment becomes effective."
Unfortunately, Congress does not appear to be following that path. Current budget reconciliation legislation fails to change the SGR-based formula that is the basis for Medicare payment to physicians. Moreover, Congress might not override the 4.4 percent Medicare payment reduction that will occur in January as a result of use of the SGR.
In addition, the recent announcement of CMS' Physician Voluntary Reporting Program threatens to undermine progress made in structuring a viable pay-for-performance system, said Frank in her letter to McClellan.
"A disproportionate burden of this program falls on the shoulders of primary care physicians, whose services have been long undervalued by Medicare," Frank wrote. "Asking physicians to invest in new reporting systems, whether in a paper-based office or one using electronic health records, in an environment of a potential 4.4 percent payment cut is unreasonable."
Moreover, CMS "appears to have largely ignored" the work of the AAFP and other organizations in the Ambulatory care Quality Alliance, said Frank. High-level CMS officials were working with the alliance to develop a "starter set" of performance measures that would form the foundation of a physician reporting system.
Instead, the PVRP includes reporting measures that could apply to every Medicare patient in a family physician's practice. In addition, the program simply alters measures used by hospitals and applies them to physician offices.
The AAFP statement echoed Frank's position. "The (quality performance) measures identified have been randomly selected; do not lend themselves well to electronic reporting; may, in fact, require medical record abstraction; have not been vetted through a consensus-development process that is essential to acceptance and success; and are not all based in scientific evidence," the AAFP statement notes.
Thus, though the Academy supports pay-for-performance, "the AAFP must oppose the CMS voluntary reporting initiative, as it undermines the organized, incremental transition to the pay-for-performance methodology and is slated for implementation just as the 4.4 percent reduction of Medicare payment becomes effective."
