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Chairman Herger Announces Hearing on Physician Organization Efforts to Promote High Quality Care and Implications for Medicare Physician Payment Reform

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House Ways and Means Health Subcommittee Chairman Wally Herger (R-CA) today announced that the Subcommittee on Health will hold a hearing to explore physician organization efforts to promote high quality patient care. Understanding these initiatives will inform the Subcommittee as it continues to examine how to reform the Medicare physician payment system. The Subcommittee will hear from organizations representing the physicians who are at the forefront of patient care and therefore most knowledgeable about what may be needed to optimize care for Medicare quality and beneficiary health outcomes. The hearing will take place on Tuesday, July 24, 2012, in 1100 Longworth House Office Building, beginning at 10:00 A.M.

In view of the limited time available to hear from witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing. A list of witnesses will follow.

BACKGROUND:

Medicare currently reimburses nearly every physician on a fee-for-service (FFS) basis. While the physician fee schedule generally takes into account the work, time, and effort associated with each service, it does not account for the quality and efficiency of the care provided. Furthermore, the mechanism used to annually update the fee schedule--the Sustainable Growth Rate (SGR) formula--limits spending growth to growth in the economy but does not recognize value or quality. There is broad acknowledgement of the shortcomings of the current payment system, including the disruptive role of the SGR, and the growing importance of incentivizing patient-centered, high-quality, and outcomes-oriented care.

Physician organizations generally support the notion of incorporating quality, efficiency, and patient outcomes into the Medicare physician payment system. Many physician organizations, especially those representing the various specialty disciplines, are involved in a range of activities that increase the likelihood that these aims can be accomplished in a meaningful way. Examples of these physician-led activities include establishing evidence-based guidelines for treating common conditions, using information on actual patient encounters to measure health outcomes, and helping physicians organize their practices to be more responsive to patient needs.

In this third in a series of hearings on Medicare physician payment reform, the Subcommittee will learn more about physician-led quality initiatives such as those described above. In previous hearings, the Subcommittee heard about innovative private sector delivery models and payment reform initiatives payers are using to reward high quality and efficient care. Specialty-specific initiatives designed to support practices that are testing different payment models in the private sector can also provide a foundation from which to reform Medicare FFS payments. Recognizing that physician input is key to successfully incorporating quality and efficiency, the Subcommittee seeks to understand what physicians believe is meaningful to measure, what constitutes good practice in the care of patients, and what changes are needed to improve their practice environment.

In announcing the hearing, Chairman Herger stated "The Subcommittee is committed to reforming the Medicare payment system so that it brings more value to beneficiaries while remaining viable for physicians. I am pleased that many organizations representing different physician specialties are far along in establishing quality improvement programs including measures of quality that are important to beneficiaries and fair to physicians. Understanding what physicians have already accomplished in this area, what is underway, and what is on the near horizon will be helpful as we explore how to ensure the Medicare physician payment system incentivizes and rewards the care that results in optimal beneficiary outcomes."

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