Figuring out a better way to pay doctors might cut the cost and improve the quality of health care, but using bad quality measures could make matters worse, according to Dr. Frank Opelka.
Opelka, a medical education policy specialist who is active at the National Quality Forum, warned Congress against relying on low-quality care quality measures Tuesday, at a Medicare reimbursement strategy hearing organized by the House Ways and Means health subcommittee.
Policymakers who want to get providers to deliver care more efficiently need to use quality measures, to keep the providers from cutting costs by providing bad care or by providing too little care, witnesses said.
But “linking payment to poor quality measures will not drive the system to be more patient-centered or higher-performing,” Opelka said.
Linking payments to low-quality quality measures “will add cost and burden,” Opelka said.
Rep. Kevin Brady, R-Texas, the subcommitte chairman, organized the hearing because of worrries about rising Medicare costs; concerns that the traditional Medicare program “fee for service” payment system encourages providers to jack up revenue by providing too much care; and physicians’ anger about a proposed “sustainable growth rate” (SGR) Medicare physician pay rate cut that could slash reimbursement rates by more than 20 percent.
For years, almost every federal budget proposal has started out including SGR cut required by federal statutes. Congress has always responded to physician outrage by finding ways to postpone making any SGR cuts.
“My hope is that we can put the days of kicking the SGR can down the road behind us,” Brady said in a statement.
Private plans can use provider contract negotiations to do more to manage care than the traditional Medicare program can, but traditional Medicare program rules can have a big influence on the private health insurance market, because private plans often base their provider reimbursement schedules on the Medicare reimbursement schedule.
Dr. David Hoyt, executive director of the American College of Surgeons, testified in support of a proposal to replace the perennial SGR rate cut proposal with some new type of payment system that would give physicians an incentive to provide high-quality, efficient care.