WASHINGTON — Congress and the Centers for Medicare and Medicaid Services agree on one thing: The sustainable growth rate formula that has doctors facing an approximate 5% reduction in reimbursement in 2007 will not go into effect this year.
According to a report from the American Society of Hematology, 80 of the Senate’s 100 members signed a letter urging the full Congress to repeal the sustainable growth rate formula for the coming year.
However, repealing the sustainable growth rate formula every year only postpones the budgetary problem, and Congress agreed that it was only a Band-Aid solution.
The Committee on Energy and Commerce Subcommittee on Health heard two days of testimony from government agencies and professional medical societies on how best to design a Medicare payment system that doctors can work with and the government can afford.
“It does not seem reasonable to have a system that we never use,” Texas Rep. Joe Barton said.
The CMS support the idea of pay for performance, which administrator Mark B. McClellan, MD, said could address flaws in the current system.
“When I talk to doctors, they say they are being compensated for doing the wrong thing. They get paid more to do duplicative tests than they do to keep people well and keep them out of the hospital,” McClellan said.
However, members of Congress, particularly those who practiced medicine prior to their election, are not convinced.
“A lot of what is said about pay for performance is a slap in the face to the physician community, which does in fact provide the best health care in the world,” said Georgia Rep. Charlie Norwood, who practiced medicine prior to being elected to Congress.
During two days of hearings, the committee heard testimony from the ACC, the Alliance of Specialty Medicine, the American College of Physicians, the American Osteopathic Association, the American College of Surgeons, the Society of Thoracic Surgeons, the American Society of Clinical Oncology and the American Medical Association.
The society representatives offered their expertise as Congress works to develop a pay for performance system, and they shared concerns about government intrusion into their medical practices.
“No single pay for performance program will fit all physicians. You need to develop a program that will be unique to each specialty’s standard of care and put ownership back into the hands of physicians,” said Jeffrey B. Rich, MD, a surgeon at Mid-Atlantic Cardiothoracic Surgeons in Norfolk, Va., who spoke on behalf of the Society of Thoracic Surgeons.
John Brush, MD, a private practice cardiologist in Norfolk, Va., who spoke on behalf of the ACC, said he was concerned about a rush to pay for performance.
“Currently, there are about 100 pay for performance systems in place in the private sector, but very few studies have evaluated the utility of these systems. Pay for performance must be based on evidence, and a one-size-fits-all approach may not be wise,” Brush said.
Physician representatives agreed that any pay for performance system should include both measures of process and measures of outcome.
“In cancer treatment, it is not just whether a patient lives but how a patient lives. So any outcome measure would have to be carefully vetted and complemented by a process measure,” said Deborah Schrag, MD, an oncologist at Memorial Sloan-Kettering Cancer Center, New York, on behalf of the American Society of Clinical Oncology.
McClellan welcomed the input of physician groups. He said 34 specialty societies, which account for 90% of all Medicare spending, have already developed some sort of quality measurement.
Texas Rep. Michael Burgess, who practiced medicine prior to being elected to Congress, said he doubted whether the legislative body could come up with a workable system. “This is going to be complicated. We don’t do complicated all that well,” Burgess said. – by Jeremy Moore