Physician groups fight early pay-for-performance plan

Despite objections from the American Medical Association (AMA) and the American Academy of Family Physicians, the Centers for Medicare & Medicaid Services (CMS) is proposing an early launch of the pay-for-performance Medicare plan, reports American Medical News.

Slated to go into effect in 2015 for some and 2017 for all physicians under health reform, the value-based payment modifier could be used as early as the 2013 reporting period; it will adjust payments based on quality of care and costs incurred relative to other reports.

Citing inadequate time to prepare, AMA President Dr. Peter W. Carmel said some physicians may unfairly see their reimbursements cut based on premature performance measurements, and others may be penalized for treating difficult cases, according to the amednews article.

The American Academy of Family Physicians added, "In an age in which data and information can be quickly transmitted and processed, we fail to understand why CMS remains stuck in a mode that requires it to take months, if not years, to determine which physicians bring value to the system."

Proponents of pay for performance argue that value-based purchasing will shift the trend away from fee for service and improve quality of care, physician accountability, and cost-efficiency.

For example, Integrated Health Association in California last week announced it launched value-based pay for performance. With the largest private physician incentive program in the country, according to a press release, Integrated Health Association will include a total-costs-of-care formula, in which hospitals, professional services, pharmacy, and ancillary care providers share the savings.

"Measuring total cost of care alongside quality gives everyone a better understanding of the value of care and is a basis for comparing physician organizations," said Integrated Health Association board member David Joyner, senior vice president, Large Group and Specialty Benefits, Blue Shield of California. "This is how we move toward greater accountability without compromising quality."

For more information:
- read the amednews article
- read the press release

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