Facing yet another year under the threat of lower Medicare payments, internists 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 this year for the American College of Physicians. The ACP, along with other medical societies, is advocating for a consistent data set, such as the 26 quality measures that have been vetted by the Ambulatory Care Quality Alliance. In a document given to Congress, the ACP presented a time line for a pay-for-performance program. The program would be voluntary, but participating physicians would receive a higher payment update. Much of what will affect physician payment this year will be addressed in conference negotiations on the omnibus appropriations bill, which at press time have not been completed. Even if Congress stabilizes payments and provides a 1-year fix, “there still could be a long-term problem” with the sustainable growth rate, Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, told INTERNAL MEDICINE NEWS. “We don't know if the conference agreement will include a legislative mandate for [the Centers for Medicare and Medicaid Services] to move forward on pay for performance in 2007” or whether the program would be punitive, he said. Based on current proposed language, physicians could receive an increase for participating in quality reporting, but those who aren't able to participate may get a 2% cut in payments, he said.
Voluntary Reporting Program
Primary care groups are pressing CMS to make changes to its new voluntary reporting program, which has fueled concerns about using unfamiliar G codes to measure physician performance. The ACP in particular wants CMS to agree on a smaller set of measures that are aligned with the Ambulatory Care Quality Alliance measures, Mr. Doherty said. Currently, the agency is calling for 36 measures, “which will load up physicians with too many measures,” he said. It's expected that this voluntary program will become the basis for a federal pay-for-performance program as early as 2007. For that reason, “it's really important to get this program right, once dollars are linked to it,” he said.
Health Information Technology
The ACP continues to support efforts to help small practices implement electronic health records, and is calling for payment incentives for health information technology. The ACP wants to keep breaking down the barriers to physicians using EHRs, Mr. Doherty said. It's not enough for the college to track how many internists use EHRs–what's more important is finding out how many of these electronic systems function well enough to allow internists to participate in a quality measurement reporting program. One tool to help track this trend is the Certification Commission on Health Information Technology, which was set up by the American Health Information Management Association to create voluntary standards for health information technology. The ACP was involved in the development of this commission on several levels, Mr. Doherty said. “It started out purely as a private sector initiative, but now it has the federal government behind it to develop these standards.” The standards, focusing on interoperability and functionality, are expected early this year. “For the first time, physicians will know that there's an independent commission that will be able to tell them whether the system they're purchasing is a quality EHR system, which will greatly ease anxiety,” he said. In addition, the ACP is pressing Congress to enact a bill (H.R. 747) that would reimburse physicians who have electronic medical record systems that meet these types of certification standards and who participate in a CMS-approved quality measurement reporting program.
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.