WASHINGTON—While recognizing some positive aspects of “pay for performance,” the American Academy of Ophthalmology is disappointed that the “Medicare Value Purchasing Act of 2005,” S. 1356, fails to address the flawed SGR and the scheduled 4.2 percent cut in Medicare physician reimbursement rates scheduled for January 2006. The Academy says the bill, recently introduced by Senate Finance Chairman Chuck Grassley, R-Iowa, and ranking minority member Max Baucus, D-Mont., also has an unrealistic implementation schedule for its proposed pay-for-performance plan.

“Failure to include a fee fix demonstrates misplaced priorities,” said H. Dunbar Hoskins Jr, MD, Academy executive vice president. “The majority of patients for Eye M.D.s are Medicare beneficiaries, so cuts in Medicare reimbursement rates will disproportionately affect both ophthalmology and a substantial portion of our patient population. Stopping the cuts and fixing the SGR problem are the Academy’s highest priorities.

“Any new pay-for-performance system that rewards physicians for improving the quality and efficiency of their delivery of health care services to Medicare patients must be linked to a fee fix,” Dr. Hoskins added. “The fact is physicians do not currently have a fair and stable payment system under Medicare upon which such new programs can be built.”

The Academy does not oppose implementation of quality incentives for physicians in the Medicare system. However, the Academy is concerned about the very short timeframes required by the Grassley/Baucus bill. The quality measures reporting program and the value-based purchasing system would have effective dates of 2007 and 2008, respectively.

“The implementation timetable for the bill’s value purchasing program is unrealistic and impractical,” said Catherine G. Cohen, Academy vice president of government affairs. “The bill simply does not allow adequate time for this program to be developed and tested. Hospitals have been given much more time to work out the kinks in their quality improvement reporting systems. Physicians need the same kind of timeframe to make sure the new programs are fair, workable and actually improve quality of care.”

The Academy, together with the AMA and others, is working with House Ways and Means Health Subcommittee Chairman Nancy Johnson, R-Conn., to develop legislation that will include a fee fix and stop the schedule payment cuts.

While legislation continues to develop, the Academy is also talking to CMS and other key parties about their interest in testing quality measures. The Academy has developed some simple measures that would permit ophthalmologists’ participation in such a program.