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Pay
for performance (P4P) is incompatible with the current Medicare
physician payment formula, which calls for cuts of close
to 5 percent for the next six years, physicians insist.
The
American Medical Association and 68 other medical societies
wrote to House Ways and Means Chairman Bill Thomas (R-CA)
and Senate Finance Chair Charles Grassley (R-IA) to support
a phased-in approach to P4P. Under the societies' framework,
the current formula would be replaced with positive annual
updates based on the Medicare Economic Index (MEI).
Physicians
would receive bonus payments in 2007 for reporting data
on information technology and patient safety measures, according
to the Aug. 23 letter. Then in 2008 and 2009, they would
receive payments for reporting evidence-based quality data,
and also for participating in "more advanced quality
improvement programs."
Finally,
in 2010, physicians would receive bonuses for performance
in "evidence-based" measures and outcomes, with
adequate risk adjustment and sample size. But under the
AMA plan, physicians would always be guaranteed a "floor"
of positive updates even if they didn't receive any P4P
bonuses.
The
AMA phase-in plan is similar in some ways to the bill introduced
by Rep. Nancy Johnson (R-CT), except for the longer phase-in
time and the guaranteed positive floor.
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