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Herger Opening Statement: Hearing on Physician Organization Efforts to Promote High Quality Care and Implications for Medicare Physician Payment Reform

July 24, 2012

The Subcommittee will come to order. We are meeting today to hear from physician organizations who are working to improve the quality of care delivered to patients.  These initiatives have been shown to be successful and may hold promise as we seek to reform and update the Medicare physician payment formula.  

For the past 18 months we’ve been seeking both formal and informal input on physician payment reform from the physician community and other relevant stakeholders.  At our last hearing on this topic, we heard about private sector approaches to reforming payments.  Today’s hearing, our third in a series on reforming the flawed SGR, focuses on quality improvement activities developed by medical societies and the practical implications of these activities across physician practice settings.

We will hear shortly from physician executives, physician organizations representing both primary and procedural care, and the leaders of two group practices, all of whom are engaged in efforts that focus on improving the quality of care delivered to patients.  A common theme will be that providing optimal quality and outcomes requires setting appropriate standards, building the right infrastructure, and using the right data to measure performance.

Our intent is to hear from the physician community about how to reform the physician payment system so that quality, efficiency, and patient outcomes are accounted for in a fair and fiscally responsible manner.  As I have noted before, merely averting Sustainable Growth Rate cuts each year is not a fix.  A permanent solution has been elusive in large part because of the substantial cost associated with repealing SGR—currently estimated at nearly $300 billion over ten years.

However, this Committee must do more than just simply repeal the SGR. We must also determine how to improve the existing Medicare payment system and work with physicians to develop other payment models that preserve and promote the physician-patient relationship and reward physicians who provide high-quality and efficient care.

Many are concerned about the lack of alignment among Medicare’s current incentive programs to enhance quality, such as e-prescribing, meaningful use of electronic health records, and the so-called value-based modifier.  Such programs were generally not developed nor led by the physician community.  While some feel these programs are a step in the right direction, I am concerned about taking a “top-down, government-centered” approach to defining and rewarding quality of care.

Physician organizations have been working with their members for many years to build a solid foundation for defining and operationalizing high-quality care.  For example, many groups are actively developing evidence-based guidelines, quality performance measures, data collection tools, and clinical improvement activities.

It is my hope we can learn from and build upon these efforts as we work with the physician community to develop a 21st Century payment system.


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