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Thursday, November 12, 2009

They just can't make this stuff up!

A colleague of mine is dilligently reading the entirety of both House and Senate health care reform bills. He sent me the following amendment to the Senate Bill:

Value-Based Modifier for Physician Payment Formula: The Secretary of
Health and Human Services would be required to apply a separate,
budget-neutral payment modifier to the fee-for-service physician
payment formula. This separate modifier will not be used to replace
any portion of the Geographic Adjustment Factor. The separate payment
modifier will, in a budget-neutral manner, pay physicians or groups of
physicians differentially based upon the relative quality of care they
achieve for Medicare beneficiaries relative to cost. Costs shall be
based upon a composite of appropriate measures of cost that take into
account justifiable differences in input practice costs, as well as
the demographic characteristics and baseline health status of the
Medicare beneficiaries served by physicians or groups of physicians.
Quality shall be based upon a composite of appropriate, risk-based
measures of quality that reflect the health outcomes and health status
of Medicare beneficiaries served by physicians or groups of
physicians. In establishing appropriate quality measures the Secretary
would be required to seek the endorsement of the entity with a
contract with the Secretary under section 1890(a) of the Social
Security Act. The Secretary would also be required to take into
account the special conditions of providers in rural and other
underserved communities.
By 2017, all physician payments must be subject to this payment modifier.

I don't even know where to begin to think about this. To believe that this could be implemented in any time frame and result in a positive experience for anyone involved with Medicare (and likely all other insurance that the Feds touch) should be a test for loss of reality testing.

What will be measured as a surrogate for quality?
Who does the measuring?
How will any of these measures be assessed for actual validity?
Who makes decisions as to weighting?
Given this is by definition a zero sum game (budget neutral fashion), who decides the winners and losers?

There are over 1 billion encounters with doctors alone in the US each year. How many hours will it take to develop the appropriate quality metrics that will be applicable to even a fraction of these encounters? By 2017 all payments need to be subject to this payment modifier?

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