OBG Management: What is ACOG doing to improve this system?
Ms. DiVenere: ACOG is urging the US Congress to ensure that a better system adheres to the following priniciples:
- Medicare payments should fairly and accurately reflect the cost of care. In the final 2011 Medicare physician fee schedule, CMS is proposing to reduce the physician work value for ObGyn care to women by 11% below what is paid to other physicians for similar men’s services—exactly the opposite of what should be done to encourage good care coordination, and in direct contradiction to recommendations by the Resource-Based Relative Value Scale Update Committee (RUC). Medicare payments to obstetricians are already well below the cost of maternity care; no further cuts should be allowed for this care.
- A new payment system should be as simple, coordinated, and transparent as possible and recognize that there is no one-size-fits-all model. A new Medicare system should coordinate closely with other governmental and nongovernmental programs to ensure that information technology is interoperable, that quality measurement relies on high-quality, risk-adjusted data, and to guard against new and special systems that apply to only one program or may only be workable for one type of specialty or only certain types of diseases and conditions. ObGyns often see relatively few Medicare patients, and unique Medicare requirements can pose significant administrative challenges and inefficiencies to ObGyn participation.
- Congress should encourage, and remove barriers to, ObGyn and physician development of ACOs, medical homes for women, and other innovative models. Proposed rules on the Medicare Shared Savings Program allowing for expedited antitrust review should be extended to ACOs and other physician-led models of care that do not participate in the Medicare Shared Savings Program. These models should also recognize the dual role ObGyns may play, as both primary and specialty care providers.
- Congress should repeal the Independent Medicare Payment Advisory Board. Leaving Medicare payment decisions in the hands of an unelected, unaccountable body with minimal congressional oversight is bad for all physicians and for our patients.
The outlook for private practice, in any specialty, has dimmed. Says ACOG’s Lucia DiVenere: “Median expenses for private practices have been steadily rising in relationship to revenues—from 52% in 1990 to 71% in 2002—making it difficult for practices to remain solvent.”
Is private practice doomed?
OBG Management: In your opinion, over the long term, is health reform a positive or a negative for ObGyns in private practice?
Ms. DiVenere: On balance, I believe that the health reform law is a positive for our patients, and that fact may lead to an eventual positive for its Fellows, ACOG hopes. What it may mean for ObGyns in private practice, though, is more troubling.
The law has many intended purposes: 1) cover the uninsured, 2) tilt our health-care system toward primary care and use of nonphysician providers, and 3) push practices toward integration with hospitals and health systems and other paths to physician employment. Support for continuation or growth in any type of physician private practice is hard to find in the ACA.
OBG Management: What changes are in the pipeline?
Ms. DiVenere: Under the ACA, by 2013, the Secretary of HHS, with input from stakeholders, will set up a Physician Compare Web site, modeled after the program that exists for hospitals, using data from the Physician Quality Reporting Initiative (PQRI). Data on this site would be made public on January 1, 2013, comparing physicians in terms of quality of care and patient experience.
By law, these data are intended to be statistically valid and risk-adjusted; each physician must have time to review his or her information before it becomes publicly available; data must ensure appropriate attribution of care when multiple providers are involved; and the Secretary of HHS must give physicians timely performance feedback.
Data elements—to the extent that scientifically sound measures exist—will include:
- quality, patient satisfaction, and health outcomes information on Medicare physicians
- physician care coordination and risk-adjusted resource use
- safety, effectiveness, and timeliness of care.
Physicians who successfully interact with this program will likely be those who have a robust EHR system.
If this and other elements of the Affordable Care Act become real, however, we’ll likely see a fundamental shift in the kinds of settings in which ObGyns and other physicians opt to practice.
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