CMA Develops P4P Guidelines for Medicare and Others
“Pay for performance” is a hot topic in health care circles. Many payors, including Medicare, are considering programs to improve the quality of care provided to patients through the use of financial incentives. Indeed, two bills being considered by Congress this year would create mandatory pay-for-performance (P4P) programs for Medicare.
CMA is working to ensure that these and other P4P programs do not simply shift costs from one physician to another. CMA believes that any P4P initiative must provide for strong physician input on how “quality” is defined and measured, ensure physicians are appropriately reimbursed for clinical care, and protect patient access to care.
The bill before the Senate (S 1356) is seriously flawed. It would mandate a significant new quality measurement and quality payment process for Medicare physicians, but does not address the serious and growing access problem of the flawed sustainable growth rate (SGR) formula. The Senate bill rewards quality through bonus payments, but it also cuts reimbursement for physicians who do not meet the quality standards.
A second P4P bill will be introduced in the House of Representatives in early August. That bill would not only implement a quality measurement and a related bonus incentive payment system, but would also—at CMA’s insistence—address the larger Medicare payment problems by scrapping the current SGR formula and replacing it with the Medicare Economic Index (which measures physician practice cost inflation). The SGR formula—which allows Medicare spending on physician services to grow at the rate of the gross domestic product (GDP)— penalizes physicians because the cost of physician services rises more rapidly than the GDP. Under the current SGR formula, physician reimbursement will likely be cut by 26 percent over the next five years.
The House bill may help reshape the Senate approach, but clearly physicians need to take the lead in defining the future of Medicare reimbursement and quality measurement. To this end, CMA trustees will consider a set of guidelines for P4P programs developed by CMA’s Pay-for-Performance Technical Advisory Committee.
The trustees will also discuss a specific proposal for Medicare’s “value based purchasing” P4P program. The proposal outlines a multi-specialty and solo-friendly five-year plan to phase P4P into the Medicare program.
CMA members are encouraged to contact their trustees with comments, questions, or concerns about CMA’s forward-looking approach to quality measurement and assessment.
Click here to download
CMA's draft pay-for-performance guidelines.
Click here to download CMA's draft proposal for Medicare’s “value based purchasing” P4P program.
source: California Physician News
