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President calls for physician pay-for-performance, electronic health records
Health care consultant said ‘the handwriting is on the wall’ regarding reimbursement.
President Bush’s response to the Medicare funding warning includes provisions for pay-for-performance and the public release of physician performance measures. However, some are questioning what the changes could mean for physicians as they face a 10.6% cut on July 1.
The Medicare Funding Warning Response Act of 2008 (MFWRA) requires the Secretary of Health and Human Services to perform the following tasks:
- implement a system for nationwide interoperable electronic health records;
- create a plan for ensuring that quality measures are reported for at least 50% of care under Medicare by 2013; and
- start a system “under which a portion of the payment that would otherwise be made to individuals or entities serving Medicare beneficiaries is based on the quality and efficiency of their performance.” The system would initially be implemented in settings where measures “are well-accepted and already collected” and would have incentives for deterring geographic variation in efficiency and quality.
The bill also allows the secretary to publically release physician performance measurement on quality or efficiency.
No direction
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Some practice management experts noted that the bill used vague or “code language.” Orthopedics Today Business of Orthopedics section editor Jack M. Bert, MD, said that he was very disturbed that the bill did not make a direct mention of the 10.6% payment cut looming over physicians.
“The problem is there are no data out there that tell us exactly what is going to happen, and that is frustrating,” Bert said. “We don’t know what they are thinking. We don’t know what their timeline is and we sure as heck don’t know what pay-for-performance means in terms of reimbursement. If the reimbursement is as low as it has been, it is going to be a nightmare.
“I am worried about the majority of physicians saying, ‘Fine, we are going to limit our number of Medicare patients to X amount and that’s all we are going to see, or we are going to quit seeing them all together.”
Pay-for-performance
Robert James Cimasi, an orthopedic health care, financial and economic consultant, said that physicians should look to recent pay-for-performance provision to understand how the government will deal with the physician payment cuts.
“It talks about it, without getting specific as to what they are going to do, but I think that you can sort of look at this as if the handwriting is on the wall,” he told Orthopedics Today. “In that regard, they are talking about pricing transparency and incentives for value and quality, but not providing the metric or parameters for deciding what those terms mean. It is the details which will have a lot to do with how physicians are compensated and reimbursed.”
The new system focuses on disincentives for not meeting standards rather than truly rewarding quality. “It is a takeaway, but there is nothing specifically stated within the MFWRA itself as to how that will actually be implemented — and that is extremely ominous,” Cimasi said.
Pay-for-conformity
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Bert said he regards such a system as “pay-for-conformity.”
“They are going to basically say what we are going to get paid and then we are going to have to conform to what they are telling us we need to do, and some of that data are just outrageous,” he said.
Cimasi noted that the bill allows the secretary of Health and Human Services to select some of the quality and efficiency measures but it is not clear regarding their origin.
“It implements systems where it says that measures are well accepted and from processes already known,” he said. “But I ask – well-accepted by whom and known by whom?”
He also said that preference will be given to measures recognized through consensus-based processes. “That is again code language, and a consensus-based process has never been favorable to orthopedic surgeons,” Cimasi said.
He also noted that the potential legislation calls for the adoption of electronic health records, but does not specify a funding source. He suspects the money will have to come out of physicians’ pockets.
Transparency
“The whole question that arises from this intended transparency, disclosures and quality measuring is how is this process going to be administered?” he said. “If it is fairly administered, I have no question that this is going to favor most orthopedic providers out there. But again, the whole issue here is that this is the ‘stick’ not the ‘carrot’ and so that tells you right now where they’re heading.”
For more information:
- Jack M. Bert, MD, can be reached at 17 W. Exchange St., 307 Gallery Medical Building, St. Paul, MN 55102; 651-223-9204; e-mail: bertx001@tc.umn.edu.
- Robert James Cimasi is the president of Health Capital Consultants and can be reached at 9666 Olive Blvd, Suite 375, St. Louis, MO 63132; 314-994-7641; e-mail: rcimasi@health-capital.com.
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