Medicare eases quality reporting, warns of annual pay battles

CMS scales back its voluntary reporting system to encourage physicians to participate and prove to Congress that medicine is committed to quality.

By David Glendinning, AMNews staff. Jan. 23, 2006.

Washington -- The current struggle on Capitol Hill to prevent Medicare pay cuts likely will become an annual event for physicians unless doctors can prove they will be active players in a future pay-for-performance system, according to the program's chief.

Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, said in a recent interview that lawmakers are waiting for signs from the physician community that it is serious about improving health care by reporting how well it meets quality guidelines. In an attempt to encourage doctors to make such a good-faith showing, the agency has altered its Physician Voluntary Reporting Program to make it easier for them to participate.

Such quality reporting is the first step to a system in which Medicare or other payers reimburse based on predetermined performance standards.

"There's a strong congressional interest in not doing more than a one-year payment adjustment without seeing more visible progress in quality reporting and quality improvement programs," Dr. McClellan said. "It's more urgent than ever for us to work with the physician community to make real progress to get to a system that Congress would feel comfortable legislating on for the longer term."

A move from lawmakers to condition payment reform on performance would put a crimp in the plans of the AMA and other physician groups that for years have been pushing for a permanent overhaul of the reimbursement system. If left unchecked, the payment formula would reduce doctor pay by several percentage points each year for most of the next decade.