The American Medical Group Association, which represents most of the
nation's biggest and best-known medical groups, will try to convince
Congress that its members should be paid extra for their sizable
investments in information technology and care-management methods.
"Large medical groups have electronic medical records, electronic
registries and care managers," says Chet Speed, the AMGA's vice president
for public policy and political affairs. "We're asking Congress to create
a reimbursement system that would reimburse folks that can do real care
Speed says lawmakers can choose several ways to reward
large medical groups for this type of sophisticated, coordinated care,
including boosting rates per beneficiary, allowing practices to share
savings or adding new current procedural terminology, or CPT, billing
The push for the extra reimbursement is at the top of the
public policy agenda this year for the AMGA, whose members, including the
Mayo Clinic and the Cleveland Clinic Foundation, deliver care to more
than 50 million Americans. The Alexandria, Va.-based trade group also
plans to focus its congressional lobbying effort on broadening access to
healthcare for the uninsured and creating a new reimbursement system that
keeps pace with practice costs, Speed says.
Another big national
trade group for doctors' practices, the Englewood, Colo.-based Medical
Group Management Association, will formulate its 2007 advocacy agenda
sometime next month. But William Jessee, the MGMA's president and chief
executive officer, says the organization's top priority is to replace the
current Medicare payment system with a formula based on practice costs,
which have risen about 5% to 5.5% each year over the past decade. He says
the MGMA also will focus on administrative-simplification measures to
reduce costs and improve efficiencies.
Jessee, whose trade group
represents predominantly smaller groups but also includes larger
practices, says he remains neutral on the AMGA's reimbursement plan
because of his group's mixed membership. However, he predicted that the
proposal would draw fierce opposition from many doctors' groups.
"There's no question that Washington is trying to push for bigger
groups and more-integrated systems," says Jessee, whose association
represents about 21,000 members working in organizations that employ more
than 270,000 physicians. "It'll be interesting to see where this goes. I
think it's unlikely that we'll see major payment reform this year, but
the idea is now on the table and getting talked about."
Speed says he isn't sure how lawmakers will respond to the
AMGA's proposition that its members deserve extra money because of their
investments, size and scope. "The way budget neutrality works," Speed
says, "if there was a care-coordination (payment) program implemented,
and let's say it cost $500 million, it has to come from Medicare Part B.
We have always wanted this to be an add-on payment, but fiscal realities
being what they are, I'd be surprised if that happened."
This story initially appeared in the Jan. 29 edition of Modern Healthcare magazine.
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