AMA's Pay-for-Performance Pact Ruffles Feathers


However, it's unlikely the data will be accurate or have real meaning unless the specialty societies are involved, “either individually or through the Council of Medical Specialty Societies,” he said. “I too share the concerns of others that the data will be weak and then be used to penalize doctors' reimbursement.”

It's true that a number of specialty groups don't feel comfortable that they can meet these time lines, Dr. David Nielsen, executive vice president and chief executive officer of the American Academy of Otolaryngology-Head and Neck Surgery, said in an interview.

“Could the AMA [have] been more communicative about this agreement? Probably.” Yet some of these specialty societies may be misinterpreting its terms, he said.

There's an assumption that the AMA is going to be responsible for doing all of the specialty measures, Dr. David Nielsen said. “While those concerns are valid, it isn't going to come to that.” What these groups need to remember is that the AMA's consortium is run by the specialty societies, a process that's consensus based, he said. (The American Academy of Otolaryngology-Head and Neck Surgery is a consortium member.)

“People who are upset about this aren't comparing it to what would happen if the AMA didn't step in; that CMS would step in and do their own measures. I'd be much happier with consortium measures than any other group of measures, because the consortium is in the best position to produce patient-centered measures of medical outcomes that are driven by physicians, and are relevant and validated,” he said. He also doesn't believe the performance goals set by the agreement are insurmountable.

Ninety measures have already been developed, he said. “If every specialty society creates one measure, we would get pretty close to that goal of 140 measures by the end of the year.”

The American College of Physicians, in the meantime wants, to move even more quickly than the AMA on measure development, voluntary reporting, and pay for performance, Robert B. Doherty, the college's senior vice president for governmental affairs and public policy, said in an interview.

Physician concerns about CMS's initial draft of the physician voluntary reporting program (PVRP) had also been interpreted on Capitol Hill as a sign of opposition to quality reporting, Dr. Maves noted.

From CMS's perspective, there's no reason why the AMA's agreement shouldn't work in tandem with the PVRP, CMS spokesman Peter Ashkenaz said in an interview. The physician voluntary reporting program isn't about developing measures, it's about testing systems “on how well we can use the existing claims-based system to capture the data from the measures,” he said.

The agency is testing the system on a voluntary basis to make sure it can function in a manner that works for both providers and the Medicare program, and ultimately for the beneficiaries when CMS reports the data.

“Meanwhile, making sure we have a robust set of measures to populate this program or any follow-up program that Congress may design is the critical part of the AMA's deal with the Congress,” he said.

The key is for all of the stakeholders in performance measurement programs to stay focused on the substance, Mr. Doherty said. “We need to show Congress that the profession is committed to quality measurement and reporting.”

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