A little-known provision of the health care law (PPACA) purporting to create a “value index” for physicians in Medicare has physician groups concerned. Championed by Maria Cantwell (D-WA), the provision would require the HHS secretary to add a payment modifier to the Physician Fee Schedule based on the “relative quality and cost of care provided by physicians or physician groups.”

Just how will this be determined? According to the provision:

“Quality of care is to be evaluated on a composite of risk-adjusted measures of quality established by the Secretary, such as measures that reflect health outcomes. Costs, defined as expenditures per individual, are to be evaluated based on a composite of appropriate measures of costs established by the Secretary that eliminate the effect of geographic adjustments in payment rates and take into account risk factors ... and other factors determined appropriate by the Secretary.” [emphasis mine]

Once the quality and cost measures are established in 2012, rulemaking would begin in 2013, followed by payment based on the policy in 2014. In 2015, there would be “payment consequences” for physicians, and all physicians would be paid under this formula by 2017. 

Now, we’re all about creating value in the health care system (goodness knows it’s the only thing that will get us out of the current mess we’re in) BUT to say that the HHS secretary can determine at HHS how quality is defined is not going to work. It has to be up to the people providing care and their specialty groups to determine what is “value-based care.”

Not surprisingly, physician groups are worried about what this will mean. The Congressional Budget Office said it will be budget-neutral, but it’s a little unclear how some physicians who do well will get paid more without taking money from physicians who do not do well (again, on measures not created by doctors). Continually taking payment away from providers is not going to increase quality. It’s just going to continue to force providers to integrate their private practice into hospitals, ultimately, driving up the cost of care for the system.

At this point, it’s a little too Ivory Tower to get behind. Judging physicians based on a formula they’ll have no say in creating is not a policy the ACC can support. Consumer groups like AARP and Consumers Union better jump on issues like this with us. If these kinds of matters aren’t handled in partnership with the profession, they will result in disastrous and erroneous outcomes. 

*** Image from morgueFile (jdurham). ***

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