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The
Medicare Payment Advisory Commission's March report will
recommend that Congress immediately establish pay-for-performance
(P4P) mechanisms for physicians and other providers. Also,
the Centers for Medicare & Medicaid Services should
require more data collection on claim forms, such as prescription-drug
use and lab results.
At first,
Medicare would only put a small amount of provider payments
at risk for quality achievements, said MedPAC. But over
time the percentage would grow substantially. In the first
year, 1 percent of physicians' payments would be shifted
into a quality pool that would then be redistributed to
those providers - probably less than half of the total -
who met goals.
Some
commissioners expressed concerns about applying P4P to different
physician specialties, but the first standards would only
focus on information technology or electronic prescriptions.
Over time, though, lagging specialty groups would have to
develop their own quality measures.
Eventually,
Medicare payments should be lined up with incentives to
"be efficient" in providing care, ensuring the
most bang for each buck. If doctors choose less-efficient
treatment strategies, they should feel some of the pinch,
the commissioners said. To that end, MedPAC will call on
the CMS to gather data on each physician's "resource
use" and give each physician a confidential briefing
on how his or her efficiency compares with peers' averages.
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