CMA President Testifies Before Ways and Means Committee on Medicare Payment Reform
[Posted 05/24/07]

CMA President Anmol S. Mahal, M.D., last week testified before the powerful U.S. House Ways and Means Committee. Dr. Mahal was invited by committee chair Congressman Pete Stark (D-Calif.) to speak about Medicare payment reform.

As you know, CMA recently presented to Congress a multipronged plan to overhaul the broken Medicare payment system. CMA’s plan, which has been very well received on Capitol Hill, would, among other things, eliminate the flawed sustainable growth rate (SGR) formula, provide payment updates based on practice cost increases, and update the geographic payment localities. CMA has also proposed a number of five-year demonstration projects to study cost-saving mechanisms to coordinate care, manage volume, and reward appropriate use of medical services. Permanent implementation of worthy demonstration programs would replace the SGR spending target as the Medicare physician cost containment mechanism.

“As California physicians, we agree we must do our part to provide the highest-quality care in the most efficient possible manner,” Dr. Mahal told the committee. “We at CMA are committed to working with Congress to improve the Medicare program by sharing our knowledge of evidence-based medicine and our experience with programs that attempt to manage costs and care.”

Congressional leaders have applauded CMA for developing a proactive solution to resolve the problem, rather than just complaining about the reimbursement rate cuts.

Dr. Mahal was asked specifically to comment on peer comparison programs. Dr. Mahal participates in an IPA peer comparison program that rewards physicians through bonus payments for high marks on quality, utilization, and patient satisfaction. More important, the program fosters self-improvement by providing physicians with confidential peer comparison information, helping them better understand their practice patterns and improve patient care.

“Many California medical groups and IPAs who run sophisticated managed care systems employ utilization profiling methods, but the vast majority of these groups use them only for educational purposes,” said Dr. Mahal. “The educational aspect of comparative information is vital to the success of these programs.”

Dr. Mahal told the committee that while CMA does not have specific policy on this program, the association does support peer comparison programs as an educational tool for physician self-improvement.

However, Dr. Mahal also told the committee that before implementing any program that ties reimbursement to utilization performance, Medicare must test various program designs through demonstration projects, such as those recommended by CMA as part of its Medicare reform plan. Because of the potential impact on patient care, “many safeguards would be necessary before such a complex program could be considered in the Medicare fee-for-service system,” Dr. Mahal said.

Contact: Elizabeth McNeil, 415/8827-3376 or emcneil@cmanet.org.

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