TheInstitute of Medicine last month recommended that Congress step into the pay-for-performance fray by requiring the CMS to trim its physician payments to fund a much broader use of the measures.
Under the IOM’s recommendations, Congress would require Medicare to reduce its base payments or scheduled pay increases, and then pool that money to award providers demonstrating high-quality, patient-centered and efficient care. In its report, the IOM said it would let Congress determine by how much to decrease payments, but added it would have to be sufficient to create incentives large enough to goose doctors into action.
But how federal lawmakers might hammer out such a shift with already prickly physician groups is uncertain. Doctors already have been working hard in Washington to fight a 5.1% cut to Medicare reimbursement scheduled to take effect Jan. 1, 2007. As part of that jockeying, the American Medical Association rebuffed the chairman of the House Ways and Means Committee, which had hammered out a deal that would have blocked the 5.1% reduction and increased reimbursements by up to 2.8% for those doctors who agreed to report quality-of-care data to the government.
AMA Chairman Cecil Wilson, M.D., said in a statement that the success of the outlined IOM pay-for-performance program would hinge on whether Congress could kick in additional funds, because cuts alone wouldn’t provide enough incentive to improve performance.
But Robert Reischauer, president of the Urban Institute and a co-chairman on the IOM panel that steered the pay-for-performance recommendations, says there are many physician organizations that favor a rewards-based system.
"They have participated in a lot of nonprofit collectives where they have been able to generate performance measures," Reischauer says. For the most part, he explains, the doctors will go along with a pay-for-performance program as long as it’s done right.