Congress freezes physician pay cuts

This action followed on the heels of agreement AMA signed to develop 140 physician performance measures.

A 4.4% cut in Medicare physician payments effective at the first of the year was reversed last month. The Centers for Medicare and Medicaid Services has said that the freeze in these payment cuts will be applied retroactively to care provided between Jan. 1 and Feb. 8, the date when the legislation freezing pay cuts was signed by President Bush.

Only the conversion factor will return to the 2005 status, with the other changes in the final 2006 Medicare Fee Schedule Rule remaining in effect.

Other physician-related provisions included in the legislation will not affect 2006 billing decisions and will not take effect until 2007, according to the American Medical Association.

The AMA said that CMS will automatically adjust claims filed for services provided between Jan. 1 and Feb. 8, 2006.

AMA’s confidential agreement

Michael D. Maves, MD, the executive vice president and CEO of AMA, informed state medical associations and national medical specialty societies on Feb. 7 about a working agreement the AMA had made with Congress in December.

This agreement commits the AMA to develop 140 physician performance measures and says that physicians will report on three to five quality measures per physician to the government in 2007.

Maves said that the AMA had been asked by congressional leaders “to keep this [agreement] confidential. Recent press leaks broke the embargo,” he said in his letter to the medical societies. “The agreement did not involve any commitments that we had not previously outlined to our specialty colleagues.”

In his letter, Maves said that during the budget reconciliation process last year, the AMA “was repeatedly pressed by key congressional leaders and senior Bush administration officials to demonstrate a commitment to work with policymakers on physician quality reporting initiatives.

“Physician concerns about the initial CMS Physician Voluntary Reporting Program proposal were interpreted on Capitol Hill as a sign of opposition to quality reporting,” Maves said. He said that Congressional leaders and the Bush administration “were less inclined to address payment cuts triggered by the Sustainable Growth Rate (SGR) formula if there was insufficient progress on the quality front.”

He said that the AMA and other physician groups had opposed the Senate pay for performance provision under consideration in the reconciliation conference negotiations.

“The three committee chairs were intent on securing some commitment that physicians would work on a voluntary reporting program if the Senate provision was not included in the final conference agreement.

The Senate pay for performance provision was not included in the conference agreement,” Maves said in his letter.

The AMA agreement to develop the performance measures represents work that previously had been completed by the Physician Consortium for Performance Improvement or work that was in the “planning stages at the end of last year,” Maves said.

Even though the AMA agreement was made without involvement by other physician groups, Maves said the AMA welcomes their involvement and collaboration. “However, we did not commit any individual state or national specialty society to the activities outlined in the agreement with the three congressional chairmen.”

AMA’s previous recommendations

In early December and before the agreement was signed between the AMA and Congress, the AMA had told CMS Administrator Mark McClellan, MD, PhD, that it was doubling its staff dedicated to developing the consortium measures.

It argued then that positive increases in Medicare physician payments in 2006 and 2007 should be included in legislation, and it said that CMS and physician groups would “reach agreement on a starter set of evidence based quality measures for a broad group of medical specialties” in 2006.

The AMA also had recommended in December the following steps to improve the physician voluntary reporting program: work to consider voluntary reporting hospital/facility measures in early 2006 for conversion to physician level measures, fast-track approval of CPT II codes to lower the number of possible codes for physician reporting, accelerate the development of measures to ensure that a uniform set of measures are used by all parties, as well as other recommendations.

By 2007, the AMA recommended in early December, voluntary reporting to CMS of three to five quality measures per physician could begin.

Details to be negotiated

AMA’s agreement with Congress apparently fast tracks many of these proposals. “The legislative process involved decision points that require action on a real time basis,” Maves said in his letter.

He said that the agreement is “not contrary to AMA policy. The details of a pay for performance program and additional payments for quality reporting will have to be negotiated in subsequent legislation and regulations.”