Physicians Weigh In on SGR Debate

The physicians at the roundtable emphasized rewarding quality and efficiency, and the difficulty of measuring those elements across the care continuum. "It isn't about how well I took someone's colon cancer out," explained Frank Opelka, MD, who represented the American College of Surgeons. "It's more about how well the 18 months of critical cancer care drove the best outcome for that quality."

Opelka called for a business model balanced "so everyone is aligned and we all have shared incentives."

Stream noted that the measures of quality outcomes should be different for specialists and primary care physicians because much of that care involves the treatment of chronic illness, where the payback for good outcomes might take years. For his diabetic patients, for example, treatment goals include keeping them off dialysis years down the road.

"We use proxy, short-term measures like blood sugar control," he said. "They aren't really outcome measures but the timeline is too long" to measure outcomes like avoiding amputations, which can be a threat to a diabetic.

With science and physician practice standards quickly evolving, "a Medicare payment system that truly rewards quality and efficiency must be nimble enough to reflect" those changes, cautioned Barbara McAneny, MD, who spoke on behalf of the American Society of Clinical Oncology. That will require "a robust infrastructure, including measure development and a system for detailed clinical data submission, reporting, and analysis."