At a House subcommittee hearing last week, Chairman Frank Pallone, Jr. (D-N.J.), said it is time for a permanent fix for the Medicare fee-for-service physician payment system before healthcare for seniors becomes threatened.
"We need a permanent solution to this problem," Pallone said. "We should no longer settle for short-term fixes that simply kick the can down the road."
At a March 6 hearing, members of the House Committee on Energy and Commerce, Subcommittee on Health heard a number of testimonies that all agreed that the need for a fix is crucial, despite varied approaches for a cure.
According to Glenn M. Hackbarth, chairman of the congressional advisory panel, the Medicare Payment Advisory Commission (MedPAC), the problem should be viewed as a total Medicare cost problem, not just a physician cost problem.
"If the Congress chooses to use expenditure targets, the Commission has concluded that such targets should not apply solely to physicians," Hackbarth said. "Rather, they should ultimately apply to all providers."
Earlier this month, MedPAC released its report to Congress, outlining ways to address the ailing Medicare payment system.
If Congress chooses to keep the current system, something should be done to improve payment equity while improving quality and efficiency, Hackbarth said.
MedPAC's examples of reforms included:
• creating pay-for-performance programs for quality
• improving payment accuracy
• developing incentives to coordinate care
• using comparative-effectiveness information
• bundling payments to reduce overutilization
Bruce Steinwald, director of healthcare for the Government Accountability Office recommended physician profiling as part of "a package of reforms" to make the program sustainable. Profiling would not only tag and reward physicians who are practicing medicine more efficiently, it would also recognize physicians who are treating sicker, more costly patients, Steinwald said.
"A primary virtue of profiling is that, coupled with incentives to encourage efficiency, it can create a system that operates at the individual physician level," Steinwald said. "In this way, profiling can address a principal criticism of the (current) SGR system, which only operates at the aggregate physician level."
Elliott S. Fisher, MD, Professor of Medicine at Dartmouth Medical School, said Congress should consider establishing incentives to control spending growth across all providers. It should also be mindful of reducing regional disparities in spending and the development and use of accountable care organizations, he said.