A Medicare payment system focused on quality

A Medicare payment system focused on qualityA guest column by the American Medical Association, exclusive to KevinMD.com.

Every physician caring for Medicare patients knows that the current payment system isn’t working. Most seniors know it too. For much of the last decade, patients and physicians have joined together to tell their elected officials that the system is broken. The response from members of Congress has been to stave off an immediate access to care crisis by delaying Medicare cuts to physicians in the short-term.

There is bipartisan agreement that these short-term patches grow the problem and aren’t a viable long-term solution. Now, Congressional leaders are asking physicians for their ideas on how to transition to a Medicare physician payment system that provides long-term stability and supports high-quality care. The AMA is eager to work with elected officials on both sides of the aisle to create an environment in Medicare where innovations in patient care can flourish and physician practices can thrive.

We are committed to working with Congress and the administration to address both immediate and long-term concerns about Medicare. It is time for a plan that stops the cut of nearly 27 percent scheduled to hit physicians who care for Medicare patients on January 1. We need to move away from the broken physician payment structure and toward a program that ensures the best health outcomes for patients and a stable, rewarding practice environment for physicians.

The AMA has long championed the idea that physicians are natural leaders to foster and implement positive change in health care. For the last two years, an AMA-convened group of physician leaders from state and specialty medical societies have worked to develop a strategy to stop the broken payment formula and put in place payment and delivery innovations that lead to well-coordinated, high-quality patient care and reduced health care costs.

With that solid foundation in place, we recently shared with Congress physician-supported principles that can serve as the basis of the transition to a payment structure for a higher-performing Medicare program that works for patients and physicians. The principles were endorsed by more than 100 specialty and state medical societies – the vast majority of physician organizations.

The principles stress that investment in, and support of, physicians and their practice infrastructure is a crucial part of delivery and payment reform. Medicare payment updates should reflect the costs of providing services to patients and physicians’ investments in quality improvement and cost management. These core elements provide a framework to help Congress restructure the Medicare physician payment system into a program that enables healthy patients and stable physician practices while maximizing the value of our health care spending.

In a program as large as Medicare change will not happen overnight, but even small changes can make an important difference in health care quality and cost. It is important to look at health plans, regional health care collaboratives and physician specialty organizations that have developed new models of care so we can learn from their experiences and use the best ideas in Medicare.

To ensure success, Medicare should provide a way to measure progress and should also provide stability for patients and physician practices during this time of transition. By providing a variety of payment models, physicians can choose what works best for their patients and their practice.

As the nearly 27 percent cut looms on January 1, there is an opportunity now to make real, long-term progress in Medicare. Instead of a roller-coaster future of short-lived interventions, the AMA is ready to work with our elected leaders on a system that emphasizes quality innovations for patients and reduces costs so Medicare will be there for seniors now and in the future.

Jeremy Lazarus is President, American Medical Association.

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  • DinoDocLucy

    That’s nice. I like apple pie too. Srsly? What a bunch of rah-rah drivel.

    • southerndoc1

      It’s leadership like this that has made the AMA what it is today.

  • petromccrum

    I am glad to see that someone is at least attempting to correct this mess. How about working on
    the rest of the problems with the healthcare system.

  • Robert Young

    As ACA has just lifted Medicaid for primary care physcians to equal that of Medicare, and since the AMA participated in the “ACA deal” supporting it, evidently increasing Medicare payments to 27% will “make things right again”.
    But how this decreases costs in health care which is the driver of debt and deficits is hard to gauge unless physicians do twice the job they do now. Or thy can just stop taking government cases and go back to the good old days wher they had to bil patients.

  • Robert Luedecke

    I am very appreciative of the AMA for standing up for what is good for our patients. It is sometimes very difficult for us to get past the influence of our political party and our pocketbooks to see what our patients really need. We can still get most of what we want for ourselves if we remember to put the patients first. If we don’t, we just look like greedy bastards.

    • rswmd

      The AMA has intentionally and systematically destroyed primary care in order to pad the wallets of sub-specialists. Sorry, I don’t appreciate that.

  • kjindal

    One clear and easy fix (and I have suggested this many times on this blog before) is for medicare to GIVE a single common-platform web-based electronic record system to all entities with a medicare provider number, and mandate it’s use for those entities that bill medicare (physicians, PT, visiting nurses, hospitals, etc.)

    Also give such organizations FREE training, and even maybe temporary in-office support staff to streamline the adoption of this software.

    Why should we (the taxpayers) be so generous to those rich greedy doctors? Because:

    a) the docs (esp primary care docs) are NOT as rich as you might think; and

    b) docs are in a much better position to curb costs than any other vested interest in healthcare. For example, when an elderly medicare patient on 8 meds with CAD/CHF/Afib etc. is hospitalized, then optimized w/meds, then sent out to either home or ‘rehab’, almost universally there is no/poor communication, leading to frustration and increased rehospitalization. Docs don’t like this any more than patients do. So far medicare’s answer to this mess has been more “check-boxes”. So in a large nursing home, we are much more likely to see a new admission from the hospital with info on whether they got a flu shot in the hospital, than we are to see an actual discharge summary & accurate medication list. Being able to login to a website & see a typed hospital discharge summary & med list would solve this immediately.

    c) medicare and the taxpayers benefit from cutting costs, NOT physicians- If anything, doctors’ hard work in reducing hospitalization and re-hospitalization is often tedious, time-consuming, and involving lengthy discussions with unrealistic family members (and exposes us to needless liability from slimy ambulance chasers like Sebelius’ former colleagues).

    If this administration would stop taking so much money from the likes of Allscripts, and stop being in bed with the ambulance chasers, maybe something would get done. But i’m not holding my breath. And the AMA needs to be stronger in their rejection of Obama’s stance on tort reform – I think you’ve alienated many many doctors in your impotence.

    The VA had their electronic system Vista more than 10 years ago, when I was in training. And even back then it was better than the garbage systems I see in use today.

  • kjindal

    and for God’s sake, why doesn’t the AMA defend us when this administration villainizes us? Why was there no “re-education” of this president and the public when he said that surgeons are cutting off the legs of diabetics for $50,000 each, or pediatricians are ripping out kids’ tonsils because it pays better than “giving an allergy pill”. When these remarks go unchecked, the masses view them as true because it came from such high authority. Even NURSES think they are true! Surgeons (esp general & vascular) and pediatricians are among the hardest working and most altruistic workers in America, and letting then be so insulted makes me think the AMA DOESN’T GIVE A CRAP ABOUT PHYSICIANS!!! I invite you, Dr.Lazarus, to prove me wrong.