By Charles Fiegl, amednews staff. Posted Sept. 19, 2011.
Washington — Members of organized medicine are sharply critical of a plan by the Obama administration to initiate a Medicare value-based purchasing program two years before federal law requires it.
The health system reform law requires the Centers for Medicare & Medicaid Services to use a value-based payment modifier — another term for pay-for-performance — for some physicians starting in 2015. The modifier would adjust payments to physicians based on the quality of care they provide and how much cost they incur relative to their peers during the course of a reporting period, CMS said. All physicians in the program would be subject to the modifier starting in 2017.
Although the 2015 start date of pay-for-performance is mandated by Congress, CMS plans to use a 2013 reporting period to determine how pay will be adjusted for some physicians in 2015.
The American Medical Association submitted an Aug. 29 comment letter on the CMS proposed 2012 fee schedule that outlined the initial payment modifier plans. The Association is concerned that physicians could see their payments cut based on premature or unfair performance measurements.
In a statement, AMA President Peter W. Carmel, MD, said: “We strenuously object to CMS’ plan to shorten an already inadequate preparation period by basing the 2015 value-based payment adjustment on 2013 performance. In addition, the AMA cannot support the imposition of a value-based payment modifier on any physicians unless and until there is evidence that it is possible to accurately measure value without penalizing those physicians who treat the most difficult cases.”
CMS proposed using the 2013 year as the basis for the payment adjustments because not all of a physician’s claims may be processed until 2014. The agency said in the proposed fee schedule that it needs “adequate lead time to collect performance data, assess performance….
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