Quality measurement moves to center stage

WASHINGTON, D.C.-Physicians are responding to pressure from Congress and payers to demonstrate that they will adopt quality performance measurements in return for higher Medicare fees. The American Medical Assn. (AMA) and others convinced Congress to reverse a planned cut in Medicare rates to physicians for 2006; now policymakers want firm assurances that the medical profession is working seriously to promote quality.

In response, the AMA sent letters to Congressional leaders and to Mark McClellan, MD, administrator of the Centers for Medicare and Medicaid Services (CMS), promising to work collaboratively to establish 140 evidence-based performance measures by the end of this year. This represents an expanded effort to support CMS' Physician Voluntary Reporting Program (PVRP), which is considered a first step toward a broader pay-for-performance (P4P) reimbursement system. AMA and CMS aim to agree on a "starter set" of three to five evidence-based quality measures for voluntary physician reporting beginning in 2007; AMA wants Medicare to pay a 0.4% bonus to all physicians who report on these measures to cover the cost of additional data collection.

DEVELOPING MEASURES

These activities became front-page news in February when several medical specialty groups raised concerns that it would be difficult to deliver 140 final measures. Their larger fear was that AMA-backed standards would ignore the needs of other physician groups and would support a P4P system without assurances that Congress would resolve the Medicare payment problem for the long-term.

All sides agree that the current sustainable growth rate (SGR) system for setting Medicare physician fees is not sustainable. Medicare physician payments are scheduled to be reduced a hefty 5% in 2007. Physician groups want a totally new Medicare payment system, which policymakers want to link to a value purchasing system based on evidence-based clinical measures and electronic medical records systems. The SGR formula penalizes physicians for increasing their volume of patient care, which "is on a collision course" with P4P, Nielsen commented.