Medicare’s P4P Program Under Fire Before It Has Begun

Whatsoever the 109th Congress soweth, so shall the 110th Congress reap. Just before adjourning last month, the outgoing Congress passed legislation that would set up a pay-for-performance program in Medicare. The reviews, by critics who can wield votes as well as opinions, have been mixed, and there is already doubt about the law surviving in its present form.

Democratic Rep. Pete Stark, a name very much bound to health care debates during much of the Clinton administration, is rising from the ashes thanks to the Democratic takeover of the House in November. Stark is slated to become chairman of the House Ways and Means Subcommittee on Health.

“The entire concept of pay for performance is offensive,” he tells the New York Times. Providing high quality care is the bare-bones job definition of a physician, he says. Doctors shouldn't be paid more for doing so.

The legislation freezes Medicare payments for 2007 at the current level, but also provides a 1.5 percent increase for physicians who agree to report data on how well they manage things like blood pressure for diabetics or medications for heart attack patients.

Catherine G. Cohen, vice president of the American Academy of Ophthalmology, says that the measure could “impose a significant new burden on doctors' offices.”

Stakes are high. Health plans have long sought a system of standards to hold physicians to, something not lost on Republican Rep. Charlie Norwood, who tells the Times that neither insurers nor government should tell doctors how to practice.

Not lost on anybody is the likelihood that health plans will have an easier time installing pay-for-performance programs if they claim to be following the government's example.

Of course, most health plans already pay for performance. However, there has long been a call for a single program based on generally accepted national practice guidelines because of the wide variation in quality from region to region.

Who should measure physician performance and how it should be done is increasingly under fire, and P4P proponents are not going to give up without a battle.

“Medicare pays the same amount regardless of quality,” Republican Sen. Charles E. Grassley tells the Times. He adds that Medicare “rewards poor quality” by paying doctors, according to the newspaper, to treat complications caused by their mistakes.