Healthcare Business News

Providers want Medicare payment changes tied to quality

By Rich Daly
Posted: November 13, 2012 - 2:45 pm ET

Healthcare providers are pushing for Medicare payment changes based on quality during the recently started post-election lame duck session of Congress.

Premier healthcare alliance is urging Congress to ensure that if a scheduled 2% cut to Medicare providers does go into effect next year, it will not apply to hospitals that have enacted demonstrable cost reductions. Blair Childs, Premier's senior vice president for government affairs, said in an interview that the alliance of more than 2,700 hospitals is urging a requirement that the CMS calculate the extent to which hospitals have reduced their Medicare costs recently when applying the deficit-related across-the-board cut.

“That ought to be factored into your reduction, so don't penalize them twice,” he said. “Overall, hospitals are at the forefront of quality-related health reforms; none of the other payments styles are anything like this, and there should be some recognition in the process.”

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Childs argued that his member hospitals already have enacted enough cost-saving initiatives in recent years to allow many of them to begin to reducing their bed counts.

Similarly, the American Medical Group Association is urging Congress to create a “carve-out” within the Medicare physician payment system that would increase payments for practices that meet the definition of a proposed “high-performing health system.”

“There is a large number that do not meet this definition within AMGA, but we think this is what everybody has to aspire to,” said Donald Fisher, president and CEO of the organization representing practices employing more than 125,000 physicians.

The proposal is bound to generate concerns from many physicians because it would mean higher payments to high-quality providers through cuts to every other non-qualifying physician.

The provider advocates discussed their groups' lame duck priorities during the annual conference of the National Business Coalition on Health, of which Modern Healthcare is a sponsor.

The provider advocates' push for quality payment initiatives comes amid their and other provider organizations' ongoing efforts to get legislators to eliminate or delay both a looming 27% cut in Medicare physician payments and a 2% Medicare provider cut, which stemmed from failed deficit-reduction negotiations.

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