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    Bill would delay implementation of pay-for-performance reporting program

    Would allow more orderly transition to new reimbursement system


    Priscilla Arnold, MD
    Washington—A group of medical specialty organizations, including AUA, is pushing new legislation that would delay permanent implementation of Medicare's "pay for performance" quality reporting program to allow for a more orderly transition to the new system of Medicare reimbursement.

    Sponsored by Senators Benjamin L. Cardin (D-MD) and Arlen Specter (R-PA), the Voluntary Medicare Quality Reporting Act of 2007 was introduced in late May on behalf of the Alliance of Specialty Medicine, of which AUA is a member. The Alliance represents more than 200,000 physicians nationwide.

    Introduced in the House of Representatives by Bart Gordon (D-TN) and John Shadegg (R-AZ) in mid-June, the legislation would amend the provision in the Tax Relief and Health Care Act of 2006 that requires the Centers for Medicare & Medicaid Services to develop a new quality reporting program for 2008, even before a 6-month trial of the 2007 Physician Quality Reporting Initiative (PQRI) is completed.

    Bob Gatty
    "Last year's act establishing the Physician Quality Reporting Initiative has a number of shortcomings," said Priscilla Arnold, MD, speaking for the Alliance. "It does not provide sufficient time to evaluate the trial 6-month PQRI before moving forward, nor does it establish a clearly defined process for developing and endorsing quality measures, making certain the measures are developed through the American Medical Association's Physician Consortium by the medical specialties."

    Sen. Cardin
    The Voluntary Medicare Quality Reporting Act of 2007 would require the Department of Health and Human Services to evaluate the 6-month PQRI and report the findings to Congress by June 1, 2008. After the evaluation is completed, a voluntary Medicare quality reporting program would commence. Implementation would begin on Jan. 1, 2010, based on "a consistent set of rules that define an orderly and transparent process of quality measure development and endorsement," according to the Alliance.

    In introducing the bill, Cardin pointed out that the PQRI program was established last year when Congress prevented a scheduled across-the-board cut of 5.1% in Medicare physician reimbursement rates and froze payment levels. Under PQRI, providers became eligible for a one-time bonus payment of 1.5% of total allowed Medicare charges if they reported certain quality measures starting in July 2007.

    "Everyone wants the best possible care for Medicare beneficiaries," Cardin said, "but I am very concerned about moving forward with standards that have not been adequately tested. We must have the right process in place for defining quality measures, and a good system needs sufficient time to assess its appropriateness and effectiveness."

    Key components of the bil include:

    • A uniform process would be established to identify medical conditions for which quality measures are developed, endorsed, and implemented.
    • Demonstration projects would help establish mechanisms for physicians to report data through an appropriate medical registry.
    • Physicians could continue reporting on measures developed in the 2007 trial program so HHS could refine reporting systems.

    Fast Facts
    According to the Alliance, the act "would also establish what physicians have long recommended: the involvement of medical organizations in establishing quality measures." The AMA's Physician Consortium for Performance Improvement would designate clinical areas needing quality measures. In collaboration with medical specialty organizations and others, the consortium would develop quality measures that would be forwarded to a consensus organization, such as the National Quality Forum, for endorsement.


    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.