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Health Plans Urge Uniform Measures for Performance-Based Medicare Payment

APRIL 25, 2005 -- Managed care executives urged federal policy makers Monday to support uniform standards that would be used by both government programs and private health plans to measure the performance of doctors in delivering "ambulatory" care—treatment of patients who aren't hospitalized.

Insurers and medical groups are working on a common set of standards and their embrace by the Centers for Medicare and Medicaid Services (CMS) would be a key step toward starting performance-based payment of doctors in Medicare, observers say.

Without a uniform set of standards, medical offices won't have the time or administrative staff to report data showing how individual doctors do on the performance measures, analysts say.

Speaking at a Capitol Hill briefing sponsored by America's Health Insurance Plans (AHIP), Dr. Samuel Nussbaum, chief medical officer at Wellpoint Inc., urged congressional aides to encourage CMS to work with industry on common standards. Dr. W. Allen Schaffer, senior vice president at Cigna, added that the lawmakers should increase funding of research by the Institute of Medicine and the Agency for Healthcare Research and Quality (AHRQ) to improve the quality of health care.

AHIP President Karen Ignagni also urged greater funding of AHRQ to help speed the widespread adoption of medical research findings by the National Institutes of Health (NIH). NIH gets $30 billion a year in funding but AHRQ's budget to help spur adoption of those and other findings on how to improve care is only about one percent of the NIH budget, Ignagni said.

As health costs keep rising at a steady clip, both Congress and the Bush administration are struggling with ways to increase the value purchasers get for their health care dollar. Those efforts now center on attempts to promote payment based on quality, including in Medicare.

A CMS spokesman said the agency is working with industry through the National Quality Forum to agree on common standards and is part of a group called the Ambulatory Quality Care Alliance that aims to have uniform measures ready later this year that doctors can use to begin reporting data on a voluntary basis. There's much speculation, however, that Congress will pass legislation later this year requiring doctors to have to begin reporting such data as soon as next year in order to avoid Medicare payment cuts.

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