Physician Payment Reform
By January 2012, the Secretary for Health and Human Services (HHS) will be required to report her recommendations for physician payment reform to Congress in compliance with the Patient Protection and Affordable Care Act (ACA). At a recent meeting of the Specialty Society CEO Coalition, more than two dozen CEOs of major national medical specialty societies shared the collective concerns of our members about some of the models being proposed for physician payment reform. Although this column is too short to share every concern, your elected leaders and professional staff are sharing ideas and providing input on the following issues, among others. The ACA includes quality improvement provisions, but the value to our healthcare system is unproven. Specific concerns include: Requiring physicians to face future Medicare cuts/penalties if they don’t participate in the Physician Quality Reporting System (PQRS) before specialty-specific quality elements are developed, validated, and feasible. Developing a new budget-neutral payment modifier based on the relative quality and cost of care founded on an extensive composite of risk-adjusted measures of quality – although no such system now exists, nor is it possible to complete any time soon. Requiring HHS to publicly report individual physician quality and resource use prematurely (Physician Compare), while lacking reliable, risk-adjusted, valid, and feasible measures and systems for collecting and reporting clinical outcomes data. There are potential barriers to the widespread adoption of health information technology for the Electronic Health Record Incentive Program and Meaningful Use (MU), including the need for: Greater flexibility; More time to achieve MU; Lack of small physician practice representation on the Health IT Policy Committee; Adequate specialty-specific integrated electronic health records and systems; Less burdensome reporting requirements; Funds and funding mechanisms; and Greater attention to operational issues. The volatility and instability of the current Medicare physician payment system (Sustainable Growth Rate or SGR formula) is threatening Medicare beneficiaries’ access to surgical care and making it difficult for physicians to effectively manage their practices. The flawed SGR formula must be repealed and replaced with a system that accurately reflects the natural increases in the costs of delivering high quality healthcare. Continued threats of impending payment cuts, rising practice costs, and a lack of certainty going forward, make it difficult, if not impossible, for already financially challenged practices to continue to treat Medicare patients. Accountable Care Organizations (ACOs), bundled payments for defined episodes of care, and gainsharing are three mechanisms that are being examined and tested as possible means to encourage collaboration among physicians, hospitals, and other relevant providers by aligning incentives to improve the quality of care and lower costs. Among other things, we are specifically concerned that: Alternative payment systems may not have sufficient physician leadership or input, and may not be patient-centered or quality driven; Not all patients and physicians may be able to participate in these new structures; and Patients and physicians who cannot or choose not to participate, even for reasons beyond their control, may be unfairly penalized. Also, we continue to challenge the implementation of the Independent Payment Advisory Board (IPAB), an unelected, unaccountable body of individuals appointed solely by the President and charged with creating Medicare payment policy. By limiting Congressional authority and oversight, the IPAB essentially eliminates the transparency of hearings, debate, accountability, and the meaningful opportunity of stakeholder input. Fewer than half of the IPAB members can be healthcare providers, and none are permitted to be practicing physicians or be otherwise employed. It is doubtful that an appropriate perspective of practicing physicians and patients can be obtained, and we are concerned that this group would recommend additional payment cuts to physicians without this perspective or additional Congressional oversight. Your Academy professional staff and leaders continue to work for you by participating in the discussions with other physician organizations and federal government representatives regarding federal plans to implement sections of the PPACA that have the potential to affect you the most. By joining with other organizations and participating in these meetings held by federal agencies, we are working to ensure that CMS and health plans address and eliminate barriers to quality care, assure relevant and feasible reporting requirements, and fair payment policy. Please continue to read the weekly The News and check the AAO-HNS Practice and Advocacy webpage (http://www.entnet.org/practice/) for the most up-to-date information on these programs in preparation for implementation of payment reform over the next few years.

By January 2012, the Secretary for Health and Human Services (HHS) will be required to report her recommendations for physician payment reform to Congress in compliance with the Patient Protection and Affordable Care Act (ACA). At a recent meeting of the Specialty Society CEO Coalition, more than two dozen CEOs of major national medical specialty societies shared the collective concerns of our members about some of the models being proposed for physician payment reform. Although this column is too short to share every concern, your elected leaders and professional staff are sharing ideas and providing input on the following issues, among others.
The ACA includes quality improvement provisions, but the value to our healthcare system is unproven. Specific concerns include:
- Requiring physicians to face future Medicare cuts/penalties if they don’t participate in the Physician Quality Reporting System (PQRS) before specialty-specific quality elements are developed, validated, and feasible.
- Developing a new budget-neutral payment modifier based on the relative quality and cost of care founded on an extensive composite of risk-adjusted measures of quality – although no such system now exists, nor is it possible to complete any time soon.
- Requiring HHS to publicly report individual physician quality and resource use prematurely (Physician Compare), while lacking reliable, risk-adjusted, valid, and feasible measures and systems for collecting and reporting clinical outcomes data.
There are potential barriers to the widespread adoption of health information technology for the Electronic Health Record Incentive Program and Meaningful Use (MU), including the need for:
- Greater flexibility;
- More time to achieve MU;
- Lack of small physician practice representation on the Health IT Policy Committee;
- Adequate specialty-specific integrated electronic health records and systems;
- Less burdensome reporting requirements;
- Funds and funding mechanisms; and
- Greater attention to operational issues.
The volatility and instability of the current Medicare physician payment system (Sustainable Growth Rate or SGR formula) is threatening Medicare beneficiaries’ access to surgical care and making it difficult for physicians to effectively manage their practices. The flawed SGR formula must be repealed and replaced with a system that accurately reflects the natural increases in the costs of delivering high quality healthcare. Continued threats of impending payment cuts, rising practice costs, and a lack of certainty going forward, make it difficult, if not impossible, for already financially challenged practices to continue to treat Medicare patients.
Accountable Care Organizations (ACOs), bundled payments for defined episodes of care, and gainsharing are three mechanisms that are being examined and tested as possible means to encourage collaboration among physicians, hospitals, and other relevant providers by aligning incentives to improve the quality of care and lower costs. Among other things, we are specifically concerned that:
- Alternative payment systems may not have sufficient physician leadership or input, and may not be patient-centered or quality driven;
- Not all patients and physicians may be able to participate in these new structures; and
- Patients and physicians who cannot or choose not to participate, even for reasons beyond their control, may be unfairly penalized.
Also, we continue to challenge the implementation of the Independent Payment Advisory Board (IPAB), an unelected, unaccountable body of individuals appointed solely by the President and charged with creating Medicare payment policy. By limiting Congressional authority and oversight, the IPAB essentially eliminates the transparency of hearings, debate, accountability, and the meaningful opportunity of stakeholder input.
Fewer than half of the IPAB members can be healthcare providers, and none are permitted to be practicing physicians or be otherwise employed. It is doubtful that an appropriate perspective of practicing physicians and patients can be obtained, and we are concerned that this group would recommend additional payment cuts to physicians without this perspective or additional Congressional oversight.
Your Academy professional staff and leaders continue to work for you by participating in the discussions with other physician organizations and federal government representatives regarding federal plans to implement sections of the PPACA that have the potential to affect you the most. By joining with other organizations and participating in these meetings held by federal agencies, we are working to ensure that CMS and health plans address and eliminate barriers to quality care, assure relevant and feasible reporting requirements, and fair payment policy.
Please continue to read the weekly The News and check the AAO-HNS Practice and Advocacy webpage (http://www.entnet.org/practice/) for the most up-to-date information on these programs in preparation for implementation of payment reform over the next few years.