AGS CONTINUES EFFORTS TO SHAPE PAY-FOR-PERFORMANCE POLICY

Pay-for-performance programs have been part of the healthcare landscape since the 1990s, when private insurers began offering providers bonuses for meeting specified quality and cost-effectiveness standards. An estimated 30 million Americans now belong to HMOs and other health plans and networks with “P4P” programs. And that number is likely to increase dramatically in the coming years as efforts to introduce P4P into Medicare gain ground.

A wide array of policymakers and stakeholders, including the Centers for Medicare & Medicaid Services (CMS), Congress, nongovernmental organizations, and medical societies are now involved in efforts to shape Medicare P4P. CMS, which launched a nationwide P4P demonstration involving10 large medical practices a year ago, is about to roll out another demonstration, the Physician Voluntary Reporting Program. A P4P preview of sorts, the program offers physicians the option of giving CMS information about the care they provide to Medicare beneficiaries and receiving feedback regarding their performance. Late this year or early next, CMS’ Nursing Home Pay for Performance Demonstration, which promises bonuses for meeting to-be-established standards, is slated to begin as well.

As this issue of Annals of Long-Term Care went to press in mid-December, Congress was also considering legislation concerning P4P. (Readers are encouraged to visit www.americangeriatrics.org for an update on congressional action.) Just a few weeks before that, the Institute of Medicine (IOM) issued a report calling for a universal and comprehensive system for measuring and reporting healthcare quality. Such a system, the IOM noted, is necessary if pay-for-performance policy is to effectively improve healthcare quality.

Aware that efforts to introduce P4P into Medicare were gaining momentum, the American Geriatrics Society stepped up its efforts to shape pay for performance well over a year ago. Since then, AGS leaders and staff have been meeting regularly with key CMS and congressional staffers. The AGS drafted the “American Geriatrics Society Pay for Performance Proposal” last year, reiterating its support for tying payment to quality, but emphasizing that quality measures must assess the care of all Medicare beneficiaries—including those over age 75, those with multiple chronic illnesses, the frail, and those receiving palliative care. The proposal recommends the inclusion of performance measures that have been tested among vulnerable older adults, and measures that recognize the unique needs of end-of-life patients. It advocates using RAND’s Assessing the Care of the Vulnerable Elders (ACOVE) measures for falls, cognitive screening, functional assessment, end-of-life counseling, osteoporosis, and other health problems affecting older adults. (For the full proposal, visit www.americangeriatrics.org and click on the Public Policy button on the lefthand tool bar.)

In addition, AGS and other medical groups have advocated to have the Sustainable Growth Rate (SGR) formula rescinded before P4P policy is adopted. So too, the AGS has called for meaningful P4P performance bonuses, on top of guaranteed baseline payments, arguing that pay for performance should not be a “zero sum” or “budget neutral” proposition that would cut payments to some providers in order to reward others. To give providers time to prepare, AGS and 70 other national medical societies are advocating a five-year phase-in of P4P, as well.

To date, CMS has endorsed three of AGS’ proposed measures. AGS has been working to influence elements of congressional proposals, as well. (For more, visit www.americangeriatrics.org.)

Numerous issues concerning Medicare P4P remain to be resolved over the next few years. The scope and design of the quality measures, and the nature of incentive payments, are chief among them. AGS is committed not only to advocating for P4P policy that ensures high-quality care for older adults, but to keeping you informed of developments in this area. Watch this space, and www.americangeriatrics.org, for updates.