AMA Pay-for-Performance Pact Stirs Debate

Abstract

Specialty organizations are concerned the American Medical Association is unilaterally setting performance goals that physicians will not be able to meet.An agreement between the AMA and leaders in Congress outlines a 2-year timeline for establishing performance measures “to improve voluntary quality reporting to congressional leadership,” AMA Chair Duane M. Cady said in a statement.Dr. Cady signed the pact at the end of last year, although the details weren't publicly disclosed until several months later. The terms were outlined in a Feb. 7 memorandum from AMA Vice President Michael Maves to the state medical associations and national specialty societies.The plan was signed by Sen. Charles E. Grassley (R-Iowa), chairman of the Senate Finance Committee, Rep. Bill Thomas (R-Calif.), chair of the House Ways and Means Committee, and Rep. Nathan Deal (R-Ga.), chair of the House Energy and Commerce Subcommittee on Health.If the plan succeeds, physician groups will work with the Centers for Medicare and Medicaid Services to agree on a starter set of evidence-based quality measures for a broad group of specialties, with a goal of developing approximately 140 physician measures covering 34 clinical topics by the end of this year.The AMA has been working on these quality initiatives for some time, Dr. Cady said. “For the past 5 years, the AMA has convened the Physician Consortium for Performance Improvement, which includes more than 70 national medical specialty and state medical societies.” To date, the consortium has developed more than 90 evidence-based performance measures, he said.The consortium has not yet tested the physician measures; it has been working with several groups to do so, including the Ambulatory Care Quality Alliance, said Dr. Nancy Nielsen, speaker of the AMA's House of Delegates. The alliance is receiving funding from the Agency for Health Research and Quality and CMS to test 26 measures at six clinical sites, beginning May 1. Those 26 measures include some that were developed by the consortium.Then next year, doctors who report on 3–5 quality measures would see increased payments from Medicare. By the end of next year, physician groups should have developed performance measures “to cover a majority of Medicare spending for physician services,” the agreement said. Other initiatives, such as working on methods to report quality data, also were outlined in the agreement.As far as Dr. Cady is concerned, nothing in the pact should be a surprise. The steps had been documented in public letters to Congress and the administration and distributed to specialty societies, he said. Yet, some consortium members said they had no notice of AMA plans to sign the pact.“This is an agreement signed with leaders on Capitol Hill on how pay for performance should be laid out, and some groups feel they should have been a part of it,” Cynthia A. Brown, director of advocacy and health policy at the American College of Surgeons, said in an interview.A number of specialty groups don't feel comfortable that they can meet the timelines, according to Dr. David Nielsen, executive vice president and chief executive officer of the American Academy of Otolaryngology-Head and Neck Surgery.“Could the AMA [have] been more communicative about this agreement? Probably.” Yet, some specialty societies may be misinterpreting its terms, he said.There's an assumption that the AMA is going to be responsible for doing all of the specialty measures, Dr. David Nielsen said. “While those concerns are valid, it isn't going to come to that.” What these groups need to remember is that the AMA's consortium is run by the specialty societies, a process that's consensus-based, he said.“People who are upset about this aren't comparing it to what would happen if the AMA didn't step in: that CMS would step in and do their own measures. I'd be much happier with consortium measures than any other group of measures—because the consortium is in the best position to produce patient-centered measures of medical outcomes that are driven by physicians, and are relevant and validated.”The American College of Physicians wants to move even swifter than the AMA on measure development, voluntary reporting and pay for performance, said Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy.Physician concerns about CMs' initial draft of the Physician Voluntary Reporting Program had also been interpreted on Capitol Hill as a sign of opposition to quality reporting, Dr. Maves noted.From CMs' perspective, the AMA agreement should work in tandem with the PVRP, spokesman Peter Ashkenaz said. The key is for all of the stakeholders in performance measurement programs to stay focused on the substance, Mr. Doherty said. “We need to show Congress that the profession is committed to quality measurement and reporting.” Specialty organizations are concerned the American Medical Association is unilaterally setting performance goals that physicians will not be able to meet. An agreement between the AMA and leaders in Congress outlines a 2-year timeline for establishing performance measures “to improve voluntary quality reporting to congressional leadership,” AMA Chair Duane M. Cady said in a statement. Dr. Cady signed the pact at the end of last year, although the details weren't publicly disclosed until several months later. The terms were outlined in a Feb. 7 memorandum from AMA Vice President Michael Maves to the state medical associations and national specialty societies. The plan was signed by Sen. Charles E. Grassley (R-Iowa), chairman of the Senate Finance Committee, Rep. Bill Thomas (R-Calif.), chair of the House Ways and Means Committee, and Rep. Nathan Deal (R-Ga.), chair of the House Energy and Commerce Subcommittee on Health. If the plan succeeds, physician groups will work with the Centers for Medicare and Medicaid Services to agree on a starter set of evidence-based quality measures for a broad group of specialties, with a goal of developing approximately 140 physician measures covering 34 clinical topics by the end of this year. The AMA has been working on these quality initiatives for some time, Dr. Cady said. “For the past 5 years, the AMA has convened the Physician Consortium for Performance Improvement, which includes more than 70 national medical specialty and state medical societies.” To date, the consortium has developed more than 90 evidence-based performance measures, he said. The consortium has not yet tested the physician measures; it has been working with several groups to do so, including the Ambulatory Care Quality Alliance, said Dr. Nancy Nielsen, speaker of the AMA's House of Delegates. The alliance is receiving funding from the Agency for Health Research and Quality and CMS to test 26 measures at six clinical sites, beginning May 1. Those 26 measures include some that were developed by the consortium. Then next year, doctors who report on 3–5 quality measures would see increased payments from Medicare. By the end of next year, physician groups should have developed performance measures “to cover a majority of Medicare spending for physician services,” the agreement said. Other initiatives, such as working on methods to report quality data, also were outlined in the agreement. As far as Dr. Cady is concerned, nothing in the pact should be a surprise. The steps had been documented in public letters to Congress and the administration and distributed to specialty societies, he said. Yet, some consortium members said they had no notice of AMA plans to sign the pact. “This is an agreement signed with leaders on Capitol Hill on how pay for performance should be laid out, and some groups feel they should have been a part of it,” Cynthia A. Brown, director of advocacy and health policy at the American College of Surgeons, said in an interview. A number of specialty groups don't feel comfortable that they can meet the timelines, according to Dr. David Nielsen, executive vice president and chief executive officer of the American Academy of Otolaryngology-Head and Neck Surgery. “Could the AMA [have] been more communicative about this agreement? Probably.” Yet, some specialty societies may be misinterpreting its terms, he said. There's an assumption that the AMA is going to be responsible for doing all of the specialty measures, Dr. David Nielsen said. “While those concerns are valid, it isn't going to come to that.” What these groups need to remember is that the AMA's consortium is run by the specialty societies, a process that's consensus-based, he said. “People who are upset about this aren't comparing it to what would happen if the AMA didn't step in: that CMS would step in and do their own measures. I'd be much happier with consortium measures than any other group of measures—because the consortium is in the best position to produce patient-centered measures of medical outcomes that are driven by physicians, and are relevant and validated.” The American College of Physicians wants to move even swifter than the AMA on measure development, voluntary reporting and pay for performance, said Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy. Physician concerns about CMs' initial draft of the Physician Voluntary Reporting Program had also been interpreted on Capitol Hill as a sign of opposition to quality reporting, Dr. Maves noted. From CMs' perspective, the AMA agreement should work in tandem with the PVRP, spokesman Peter Ashkenaz said. The key is for all of the stakeholders in performance measurement programs to stay focused on the substance, Mr. Doherty said. “We need to show Congress that the profession is committed to quality measurement and reporting.”