Physicians' payment ties in with performance

November 2, 2005

A movement in Congress would link any change in Medicare payments to new requirements to improve quality of care.

A movement in Congress would link any change in Medicare payments to new requirements to improve quality of care.

In testimony before Congress, Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, said that linking payments to valid measures of quality would give physicians more direct incentives to implement approaches that result in improvements in care (NEJM 2005; 353:870-872).

McClellan outlined several initiatives the CMS has identified for this effort. One is to develop, in conjunction with the American Medical Association, quality measures of ambulatory care that will test pay-for-performance approaches.

The CMS also plans to use Medicare claims data to measure physician resources and confidentially share the results with physicians to educate them, according to the New England Journal of Medicine report.

All of this jockeying is aimed at avoiding the nearly 4.3% cut in the Medicare fee-for-service payments to physicians scheduled to take effect Jan. 1. Whether the government can tweak the formula known as the sustainable growth rate without dismantling the new prescription drug benefit to find money for physicians remains to be seen. But as the report noted, the search for compromise is already under way.