The AMA Screws Physicians By Supporting Pay-for-Performance

Despite its previous policies against pay for performance, the AMA leadership buckled under to Congressional pressure and signed an agreement supporting the implementation of this disastrous policy. I can't seem to attch the agreements to this post as a downloadable file, but I've copied them to the post. If you're interested in the actual memos and would like them to be sent, please post a comment with your e-mail.

Memo to: Executive Directors
State Medical Associations
National Medical Specialty Societies
From: Michael D. Maves, MD, MBA
Date: February 7, 2006
Subject: Joint House-Senate Working Agreement with the AMA
During the Budget Reconciliation process last year, the American Medical Association (AMA) was repeatedly
pressed by key congressional leaders and senior Bush administration officials to demonstrate a commitment to
work with policymakers on physician quality reporting initiatives. Physician concerns about the initial CMS
Physician Voluntary Reporting Program proposal were interpreted on Capitol Hill as a sign of opposition to
quality reporting. Representative Bill Thomas, Chair of the House Ways and Means Committee,
Senator Charles Grassley, Chair of the Senate Finance Committee and the Bush Administration were less
inclined to address payment cuts triggered by the Sustainable Growth Rate (SGR) formula if there was
insufficient progress on the quality front.
In letters to Dr. McClellan and congressional leaders that were distributed to state and specialty society
executives in mid-December, the AMA outlined a number of steps it agreed to take to work with CMS and
Congress on quality and physician payment issues. During a subsequent meeting with Chairman Thomas,
Chairman Grassley and Representative Nathan Deal, Chair of the House Energy and Commerce Health
Subcommittee, AMA Board Chair, Dr. Duane Cady was asked to sign a joint working agreement that contained
items the AMA previously had committed to pursue. Attached is the agreement signed by Dr. Cady, Chairman
Thomas, Chairman Grassley and Chairman Deal.
Perspectives
The AMA is working through the Physician Consortium for Performance Improvement (Consortium) to refine a
starter set of evidence based quality measures for the CMS Physician Voluntary Reporting Program. CMS has
proposed scaling back the initial set of measures from 36 to 16.
The commitment to develop 140 physician performance measures and to cover a majority of Medicare
spending, represents work either already completed by the Consortium or was in the planning stages at the end
of last year.
The AMA welcomes the involvement and collaboration of other physician groups in quality reporting activities.
However, we did not commit any individual state or national specialty society to the activities outlined in the
agreement with the three congressional chairmen.
The AMA and many other physician groups opposed the Senate pay for performance provision under
consideration in the reconciliation conference negotiations. The three committee chairs were intent on securing
some commitment that physicians would work on a voluntary reporting program if the Senate provision was not
included in the final conference agreement. The Senate pay for performance provision was not included in the
conference agreement.
The AMA Board of Trustees reviewed and approved our commitment to work with CMS and Congress on the
implementation of a voluntary quality reporting program.
The attached agreement is not contrary to AMA policy. The details of a pay for performance program and
additional payments for quality reporting will have to be negotiated in subsequent legislation and regulations.
The legislative process involves decision points that require action on a real time basis. We were asked by
congressional leaders to keep this confidential. Recent press leaks broke the embargo. The agreement did not
involve any commitments that we had not previously outlined to our specialty colleagues.
There is a lot work and many challenges ahead. The AMA has substantially increased the resources allocated to
the Consortium and other quality improvement activities. We hope you will join us in developing policies that
better serve physicians and their patients.