Managed Care Matters

There are lots of moving parts, political agendae, and battling priorities in the pay for performance movement, and it is getting even complicated-er. Today's announcement by the AMA that it will produce metrics for assessment of physician quality (registration required) is a clear indicator that financial motivations have, at least temporarily, outweighed physicians' measurement phobia.

There are two distinct but closely related and very powerful forces at work here - one financial and the other political. Financially, the key issue is concern among docs that these "quality indicators" will be used to reduce reimbursement. And that fear is not unfounded. One has to look no further than the latest Federal budget proposal and the annual battle over the mandatory reduction in Medicare physician fees to understand that the phobia has a solid foundation in reality.

Politically, Bush's pronouncements in favor of consumerism as the solution to the health care cost crisis have painted him into a corner. Critics (myself among them) have noted many problems and challenges (read near insurmountable obstacles) with this approach, chief among them its breathtakingly naïve faith in consumers' ability to somehow ferret out "information" that will enable them to make intelligent, informed decisions about medical care. Faced with criticism on this (and other points), Congress and the administration has been pushing hard to address the information deficit. And one component (but only one) of the consumer information deficit is some means of assessing physician quality. (and as difficult as that is, the complexity pales in comparison to the challenge of proving the efficacy of specific procedures and courses of treatment for specific disease states in defined populations…but that's another subject)

Faced with either doing it themselves or having others do it to them, the AMA took the lesser of two evils.

But it's still an evil. Tthe AMA's decision to develop 140 "uniform measures of the quality of care" by the end of the year is leading to conflict within the medical community, who are angry with the Association for agreeing to do this without first consulting the specialty societies (including orthopedics, neurosurgery and gynecology). And the AMA would not do that lightly; typically physicians band together to form a united front when confronted with challenges to their inalienable right to do whatever they want and charge for it. My sense is the AMA went ahead without the specialty societies precisely because they knew the societies would be a hindrance, and the stakes are too high.

The AMA's public statements about the deal with CMS to produce metrics ring true. If the docs don't come up with measures, then the Feds will; and many commercial payers are well down the quality indicator path. And commercial payers are already doing so. So the AMA has taken the smart approach, deciding to be part of the solution, and taking a leadership role in that effort, rather than their usual obstructionist tendencies.

What does this mean for you?

So far, so good...so far.

The end product may well be measures that are so pedestrian and easily attainable that they are all but meaningless. If that's the case, the AMA will have won the battle and be close to losing the war.