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MedPAC recommendations to Congress will include a quality incentive plan
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The Medicare Payment Advisory Committee will recommend to Congress that a Medicare quality-incentive payment program be created, according to two ophthalmic groups.
The commission, known as MedPAC, met earlier this month to finalize its recommendations to Congress regarding physician reimbursement. The independent commission advises Congress twice yearly, in March and June, on Medicare payment issues.
MedPAC is proposing that Medicare implement a pay-for-performance (P4P) plan that awards higher payments to physicians participate in quality programs. The initiatives would aime to control volume, increase efficiency and save Medicare money, according to a press release from the American Society of Cataract and Refractive Surgery.
The P4P concept is already in use by private insurers, mostly in primary care and chronic disease management, the American Academy of Ophthalmology said in a press release.
Concerns remain over how a P4P plan would be financed, ASCRS said in its release. The increased payments to participating physicians, probably on the order of 1% to 2 %, would come from the total physician payment pool, ASCRS pointed out.
“In this budget-neutral scenario, the money would have to be taken from the providers who do not or cannot participate,” the ASCRS press release said.
The new reimbursement models may emphasize the use of elements such as health information technology and electronic medical records, ASCRS further noted, but the cost of adopting these technological tools may fall to physicians.
“Many of these things require that physicians use health information technology and electronic medical records, which cost money, and they’re not going to be giving any money to do that. We’re talking about an unfunded mandate, if you will,” said Nancey K. McCann, director of government relations for ASCRS, in an interview.
The commission is also recommending an increase in physician payments for 2006, even though the sustainable growth rate (SGR) formula will call for a cut, according to ASCRS.
“If Congress doesn’t intervene again [with the SGR conversion factor], we have to pay back the last 2 years of the 1.5% increase, which is why we’re facing such a huge reduction in the out years,” Ms. McCann said.