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Groups Wary as Medicare Creates Measures for Judging Doctors

By Kerry Young, CQ Roll Call

March 31, 2016 -- Health professional societies and consumer groups have asked Medicare to tread carefully while overhauling its system for paying doctors, raising concerns about an agency suggestion to include guidelines from a campaign that seeks to curb the use of often unneeded procedures and treatments.

Medicare officials are awaiting White House clearance of a draft rule designed to tie payments for doctors to judgments about the quality of care they provide. The Office of Management and Budget has been reviewing this proposal since March 25. The Centers for Medicare and Medicaid Services (CMS) rule would carry out the changes mandated in last year's congressional overhaul of Medicare physician payments (PL 114-10).

CMS last year sought public comments on how to design a new payment. In a request for information, the agency raised myriad questions about how the so-called Merit-Based Incentive Payment System program for doctors could be designed.

CMS asked if there might be some benefit to weaving in new system measures from a 2012 initiative known as the Choosing Wisely program, which asked doctors to identify commonly used medical tests, treatments and procedures that may be unnecessary for many patients. More than 70 medical specialty societies have since released recommendations as part of the campaign.

The American Medical Association (AMA) told CMS that it would "premature" to use the Choosing Wisely recommendations to attempt to judge how effectively doctors have prescribed treatments and ordered tests. This phrase was echoed in comments submitted to CMS by at least five other groups, including the American Psychiatric Association.

There's been a trend toward a closer adherence to guidelines in deciding on which treatments may be appropriate for a patient, but these should not be regarded as "absolute recommendations," the AMA told CMS. Exceptions must be allowed, argued James L. Madara, the AMA chief executive officer.

"Presented with the general Choosing Wisely guidelines, a physician or patient may conclude that a particular recommendation is not appropriate in a given circumstance," Madara wrote.

As CMS seeks to curb the overuse of some treatments that provide may little benefit, it needs to make sure it doesn't discourage doctors from getting their patients needed care, wrote David Certner, legislative counsel for the seniors' group AARP, in a comment. Still, AARP would "support efforts to reduce use of overused, low-value tests and procedures, reduce waste in the health care system, and improve quality and safety of care, such as the Choosing Wisely Campaign," Certner wrote. AARP says it has nearly 38 million members.

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