AMA attacks new Medicare program on quality

The American Medical Association (AMA) is fiercely opposed to a Bush administration proposal that asks doctors to provide Medicare with reports on the effectiveness of the treatments they give their patients.

A pilot program recently launched by the Centers for Medicare and Medicaid Services (CMS) disregards the work that physician groups and others have undertaken in collaboration with the administration in recent years, the AMA maintains.

In a letter sent to CMS Administrator Mark McClellan on Thursday, AMA executives and members of the group’s board of trustees blast the agency for moving ahead on its Physician Voluntary Reporting Program on a separate track.

“CMS has bypassed a significant body of collaborative work in favor of its own reporting program,” the AMA letter states. “The physician community has made a good-faith effort to develop, endorse and implement physician performance measures.”

The doctors group calls on the administration to cancel its program and come to the bargaining table: “We recommend a fresh start on future CMS quality activities, starting with a meeting between you and physician leaders that leads to meaningful dialogue.”

The administration plan is part of a broader strategy someday to tie Medicare payments to doctors, hospitals and others to the quality of the healthcare services they provide. The notion has generated intense interest in Congress and counts among its strongest supporters Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Rep. Nancy Johnson (R-Conn.), chairwoman of the Ways and Means Committee’s Health Subcommittee.

The first step toward implementation of any such program is to establish a way to measure quality. Healthcare providers have been keenly interested in the ways that CMS wants to set those benchmarks because of the direct effect they eventually will have on their payments. The administration has already launched similar programs for hospitals and nursing homes.

“Dr. McClellan views [the reporting program] as one of many steps” toward improving the quality of medical care received by Medicare beneficiaries,” a CMS spokesman said.

A CMS press release issued when the reporting program was announced Oct. 28 seems to counter the AMA’s complaint. The statement even mentions the group by name as one of those that “provided the basis” for the administration’s proposal. The agency will continue to work with doctors and other interested groups to refine the program over time, the CMS spokesman said.

The spokesman also emphasized that doctors do not have to participate in the program to be paid by Medicare. “We’re not directing anyone to do anything,” he said.

According to the AMA, the program could find itself short of volunteers. “The excessive administrative requirements that this program will impose on physicians could doom this initiative and negate any intended quality improvements,” the letter says.

The debut of the doctor-quality-reporting program comes at a touchy moment for the physicians’ lobby. Within days of announcing the program, CMS also published a regulation setting out a 4.4 percent cut in Medicare’s payments to doctors next year.

Although physicians already were facing the cuts, the timing still rankled. The AMA maintains that the administration has the authority to mitigate the cuts without congressional action. “The administration has failed to meet its obligations to ensure Medicare patients’ access to quality care by refusing to administratively adjust the Medicare payment formula,” the letters says.

House Ways and Means Committee Chairman Bill Thomas (R-Calif.) earlier this year requested that the administration fix the payment system, but CMS has steadfastly denied it can act on its own.

The budget-reconciliation bill that recently passed the Senate includes a temporary increase in doctor payments, but the provision is not sure to survive a conference report.