Medicare Compliance & Reimbursement

MedPAC director says P4P may only evaluate IT initially.

The steamroller of pay for performance keeps pushing forward, no matter what physicians do.

"Change to Medicare's payment systems is urgently needed," because the current payment system is "neutral or negative to quality," Mark Miller, executive director of the Medicare Payment Advisory Commission testified before a hearing of the Senate Finance Committee July 27. In other words, providers often receive more payment if they provide bad care, because patients become sicker and need more care. Some Lawmakers Want Immediate P4P Finance Committee chair Sen. Chuck Grassley (R-IA) stressed the need to implement P4P for Medicare providers right away.

"What we have is a systemic failure of Medicare payment systems to reward quality, and to provide incentives to invest more in health care information technology," he said in his opening statement.

But Miller and other witnesses warned that physicians might not be as ready as hospitals to embrace P4P. 

"Measuring physician quality is more complex than measuring quality in other settings because of the lack of data, the wide variety of specialized services, and the number of physicians," Miller stressed.

He suggested that physician P4P could begin with assessing their information technology, then move on to measuring clinical processes for different diseases two or three years later.
 
CMS, AHQ At Work On 'Starter Set'
 
The Centers for Medicare and Medicaid Services is working with the Agency for Health Quality to develop a "starter set" of ambulatory care quality measures that will apply to some physicians, testified Herb Kuhn, director of the Center for Medicare Management at CMS.

CMS is also testing quality using the Physicians Group Practice Demonstration Project, involving ten multi-specialty physician groups.

During the hearing, CMS separately released its "Quality Improvement Roadmap," which details the strategies the agency is undertaking to improve the quality of health services.
  
(For more information on the Quality Improvement Roadmap, see "Feds Pave Road To Better Care With Incentives" later in this issue.)