Putting off pay-for-performance

September 1, 2007

A group of medical specialty organizations, including the American Academy of Dermatology (AAD), is pushing new legislation that would delay permanent implementation of Medicare's "pay-for-performance" quality reporting program to allow for a more orderly transition to the new system's Medicare reimbursement.

A group of medical specialty organizations, including the American Academy of Dermatology (AAD), is pushing new legislation that would delay permanent implementation of Medicare's "pay-for-performance" quality reporting program to allow for a more orderly transition to the new system's Medicare reimbursement.

Sponsored by Sens. Benjamin L. Cardin (D-Md.) and Arlen Specter (R-Pa.), the Voluntary Medicare Quality Reporting Act of 2007 was introduced late in May on behalf of the Alliance of Specialty Medicine, of which AAD is a member. The alliance represents more than 200,000 physicians nationwide.

The Voluntary Medicare Quality Reporting Act of 2007 would require the Department of Health and Human Services (HHS) to evaluate the six-month PQRI and report the findings to Congress by June 1, 2008. After the evaluation is completed, a voluntary Medicare quality reporting program would begin, with implementation beginning Jan. 1, 2010, based on "a consistent set of rules that define an orderly and transparent process of quality measure development and endorsement," according to the Alliance.

In introducing the bill, Sen. Cardin pointed out that the PQRI program was established last year when Congress prevented a scheduled across-the-board cut of 5.1 percent in Medicare physician reimbursement rates, and froze payment levels. Under PQRI, providers are eligible for a one-time bonus payment of 1.5 percent of total allowed Medicare charges if they began reporting certain quality measures in July 2007.

"Everyone wants the best possible care for Medicare beneficiaries," Sen. Cardin said, "but I am very concerned about moving forward with standards that have not been adequately tested. We must have the right process in place for defining quality measures, and a good system needs sufficient time to assess its appropriateness and effectiveness."

The bill also includes these key components:

According to the alliance, the act "would also establish what physicians have long recommended - the involvement of medical organizations in establishing quality measures."

The American Medical Association's Physician Consortium for Performance Improvement would designate clinical areas needing quality measures. In collaboration with medical specialty organizations and others, the consortium would develop quality measures, which would then be forwarded to a consensus organization, such as the National Quality Forum, for endorsement.

"For a reporting system to be meaningful, quality measures must be evidence-based and developed with the medical specialty societies who have expertise in the area of care in question," Dr. Arnold, an ophthalmologist, asserted. "Measures should conform to clinical guidelines developed by the various physician specialties."