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Standard Measures In Works For P4P Push

MANAGED CARE March 2006. © MediMedia USA
News and Commentary

Standard Measures In Works For P4P Push

MANAGED CARE March 2006. ©MediMedia USA

Uncle Sam has decided to get behind the pay-for-performance effort in a big way, something some physician associations are less than thrilled about. About 140 standard measures of doctor performance in 34 clinical areas could be in place by the end of this year thanks to an agreement reached between the American Medical Association and Congress.

The hope is that the government will use the P4P program to measure payment to physicians who treat Medicare enrollees. The agreement says that "By the end of 2007, physician groups will have developed performance measures to cover a majority of Medicare spending for physician services."

As the New York Times reports, the implications are far-reaching. "The Medicare payment for each physician service was frozen this year. Under current law, doctors face cuts of more than 4.5 percent in each of the next eight years. Congress has often intervened to prevent or delay such cuts. It could easily stipulate that doctors must report measures of clinical performance as a condition of getting even a small increase in Medicare fees."

The government says that the standards would allow payment to be based in part on, for instance, how conscientious a doctor is in prescribing beta-blockers to recovering heart attack patients.

The AMA had warned that many specialty associations may find "it difficult if not impossible" to meet the deadlines of the agreement. Sure enough, no sooner had the agreement been announced last month than 10 physician associations representing specialists protested, saying that the AMA did not insist that adequate safeguards be put in place to ensure that doctors would be paid fairly for treating Medicare patients.

"We are dismayed that an agreement was reached on issues that are critical to the future of our specialties and our patients without our participation or knowledge," the physician specialty associations wrote to Congress. "The American Medical Association cannot be the sole representative for the groups who are paramount to the development and implementation of quality measures."

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