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AMA Chair Assures Specialty Groups on Hill Agreement

FEBRUARY 24, 2006 -- The American Medical Association (AMA) has not agreed to a "pay for performance" system without accompanying changes in Medicare reimbursement, the AMA's chairman has told specialty physicians.

In a letter sent Thursday to seven medical specialty groups who criticized an agreement AMA Chairman Duane M. Cady struck with Hill leaders in December, Cady said the accord focuses on the development of a physician voluntary reporting program and additional payments to physicians who report such information in 2007. "Details of a pay for performance program will have to be worked out in future legislation," Cady wrote.

In a Feb. 10 letter to Cady, the specialty groups charged that the AMA chairman had agreed to a "pay for performance" system without any changes in the sustainable growth rate (SGR) formula that will cut Medicare payments in 2007 and beyond unless Congress takes action.

The groups also accused Cady of cutting a deal with Hill lawmakers without first consulting them, and that he agreed to an overly ambitious timetable of developing 140 physician performance measures covering 34 clinical areas by the end of this year.

While many physician groups say they support quality measures and pay for performance—which links payment to the quality of care provided—they say Congress must move cautiously because one set of quality measures will not work for all medical specialties.

In hopes of calming the specialty groups' concerns, AMA Executive Vice President Michael D. Maves sent a memo Feb. 21 to the heads of state medical associations and physician specialty societies stating the AMA did not agree to too much too soon. Representatives of the specialty groups, however, said they wanted Cady to respond to their letter.

Cady's letter covered ground similar to Maves' memo, with Cady reiterating that the AMA believes "the measure development goals outlined in the agreement are feasible."
Cady also told the specialty groups that lawmakers would not "support simply continuing to pass short-term relief to avert SGR pay cuts without substantial movement towards quality improvement."

Cady urged the medical groups to work with the AMA to resolve concerns. "If organized medicine does not work together on these challenging issues, government officials and health plans will fill the void," Cady wrote.

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