Facing yet another year with an unfixed sustainable growth rate that threatens to reduce Medicare payments, primary care physicians in 2006 will continue to focus on the developing pay-for-performance initiative, while advocating for funds to support health information technology. Medical liability reform was on the back burner in 2005, but fueled by a promise from Senate Majority Leader Bill Frist (R-Tenn.) it should appear on the table again in 2006.
Pay for Performance
Getting Congress and the federal government to understand the physician's point of view on pay for performance is a goal for primary care groups in 2006. The American Academy of Family Physicians plans to work with the Centers for Medicare and Medicaid Services to either moderate or do away with this approach in favor of more reliable data sets tied to payment reform. “Any pay-for-performance initiative that occurs should be tied to a positive Medicare update,” said AAFP President Dr. Larry Fields. The system should be simple and easy to comply with, regardless of the presence or absence of electronic health records. This is why primary care groups are advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. These measures have been widely accepted throughout the insurance industry, he said.
Resolving Coding Concerns
CMS should make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. Until changes are made, the AAFP plans to educate its members on the voluntary reporting program. “We also want changes to the relative work values that go into evaluation and management codes, to more accurately reflect the work of physicians primarily engaged in cognitive versus procedural specialties,” Dr. Fields said.
Health Information Technology
The AAFP has made headway regarding the information technology boom—use of electronic records have increased among its members from 7% in 2003 to 30% in 2005, “a tribute to the academy's diligence,” Dr. Fields said. The federal government and private insurers should invest some money into the adoption of electronic medical records, however, “so implementation is not such a financial burden,” he said. Pay-for-performance funds, for example, should be directed at small physician offices to help them adopt this technology.
Medical Liability Reform
Sen. Frist has promised to have a medical liability reform bill on the floor in 2006, specifically one that includes a cap on noneconomic damages, Dr. Fields said. “What happens every year is the House passes a fairly reasonable bill and the Senate doesn't act.” A hard cap on pain and suffering damages at $350,000 or less “is the only proven way” to reduce skyrocketing medical liability premiums, he said. The AAFP would like state legislators to use the academy's 2005 “strike force” report on what is effective in controlling liability costs, he said.
Help for Low-Income Patients
More states should adopt North Carolina's approach to Medicaid reform, Dr. Fields said. Changes brought about by the state have improved Medicaid for patients and physicians by providing beneficiaries with a medical home. “It's been shown that primary care physicians are more cost efficient and provide better outcomes than subspecialists,” he said. The AAFP has also developed a new task force on health care coverage to look at updating its 5-year-old plan to provide coverage for all patients. Evidence pointing to a health care system breakdown continues to mount. A recent study by the Center for Studying Health System Change noted that unequal access to high-quality health care is widening the gap between rich and poor patients. “Increasingly, America is turning into a country of health care haves and have-nots, driven primarily by the type of—or lack of—health coverage people have,” said lead author Robert E. Hurley, Ph.D., a senior consulting researcher at the center. The study was published as a Web-exclusive article in the journal Health Affairs.
Medicare Drug Changes in 2007
The U.S. Pharmacopeia recently issued draft revisions to the voluntary model guidelines used by Medicare Part D prescription drug plans. The revisions will apply to formularies for 2007. The revised guidelines contain the same number of unique drug categories and classes as the previous version; however, the USP is proposing changes within and across several categories. For example, the document proposes to eliminate the distinction between NSAIDs and cyclo-oxygenase-2 inhibitors and between selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. The document also proposes to add a number of medicines that might be covered either by Medicare Part B or Part D, depending on the setting. The revisions are based on the review of newly approved and discontinued drugs, changes to approved therapeutic uses, new information on the safety and efficacy of drugs, and comments since the first version of the model guidelines was issued in 2004. The 2004 model guidelines were widely used by Medicare prescription drug plans in designing their formularies, USP Vice President William A. Zeruld said at a press briefing. Three of every four formularies used the USP model guidelines in designing plans for 2006, Mr. Zeruld said. USP will submit its final proposal to CMS on Jan. 30.