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, M.D., 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 coordination." 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 codes. 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 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, M.D., 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."