Support grows to inject more cash into Medicare pay-for-performance

Key health care players' testimony before federal Medicare advisers echoes the AMA's position on programs aimed at improving patient care.

By David Glendinning, AMNews staff. Oct. 3, 2005.

Washington -- Those who are still unsure whether Medicare pay-for-performance should be based on rewards or penalties need to look no further than the advice that some outside the American Medical Association are giving, according to AMA Trustee John H. Armstrong, MD.

In recent testimony before the Medicare Payment Advisory Commission, witnesses representing a major insurer, a group of community health plans and a quality improvement nonprofit agreed that Congress must come up with more money to pay physicians who do well on federal quality measures -- not take dollars away from those who don't make the grade. This tacit endorsement of a major AMA policy from a widely representative panel indicates that broad-based support exists for a reward-based structure, Dr. Armstrong said.

"We believe that these other groups in health care delivery got it right," he said. "It's becoming apparent that the stick approach will have many consequences that hurt patient access to care. The carrot approach is one that is much more consistent with pay-for-performance programs that really want to improve quality."

WellPoint's chief medical officer, Samuel Nussbaum, MD; Alliance of Community Health Plans CEO Jack Ebeler; and National Committee for Quality Assurance President Margaret O'Kane, were the quality experts whose opinions mirrored the AMA's stance on the issue. The three appeared before MedPAC, which makes direct recommendations to Congress about reimbursements, to speak about the role of quality measurement in Medicare managed care plans.