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Physicians Push for Say in Value-Based Payments Structure

Christopher Cheney, for HealthLeaders Media, February 12, 2014

The American Medical Association is backing an effort in Congress to push Medicare toward a value-based reimbursement system, but doctors are demanding a seat at the table when rules are set for transparency and assessing providers' performance.

Physicians appear energized over a deal announced in Congress last week to repeal Medicare's fee-for-service payment system and replace it with a value-based model. But they say it is critically important for them to be involved in the process of crafting the new reimbursement scheme.

"The consensus is the fee-for-service system is unsustainable," said Peter Roman, MD, specialist medical director for Lowell General Hospital PHO in Massachusetts and a private practice orthopedic surgeon. "We need to move to a system that rewards value, with value defined as quality divided by cost."

On Thursday, members of Congress announced a bipartisan deal to repeal and replace the Sustainable Growth Rate formula, Medicare's current payment system for physicians. The pact calls for a five-year period of stability with a 0.5 percent annual pay rate hike for doctors. In the last five years of the plan, a series of reforms would be launched to push Medicare physician reimbursement to a value-based model.

Part of the SGR repeal deal calls for streamlining existing Medicare quality assessment programs for doctors and increasing transparency of medical care costs through mechanisms such as the Physician Compare service on Medicare's website.

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