WASHINGTON—The American Academy of Ophthalmology is encouraged by a much-anticipated value-based purchasing and SGR fix bill introduced today by House Ways and Means Health Subcommittee Chairman Nancy Johnson, R- Conn. If passed, the bill would derail six years of scheduled payment cuts to physicians.

“Starting Jan. 1, 2006, physicians are expected to face a 4.3 percent cut in payments due to the flawed Sustainable Growth Rate (SGR) formula for updating physician payments under Medicare,” the Academy said in a statement released today. “The bill demonstrates Rep. Johnson's understanding of the critical access problems such cuts would cause for Medicare beneficiaries across the country.”

The Academy commends her for her commitment to addressing the immediate payment problems while moving toward a pay-for-performance system.

“Stopping the cuts and fixing the SGR problem are the Academy’s highest priorities. Any new payment system tying physician payments to quality performance must be linked to a fee fix for the Academy to support it,” said Catherine G. Cohen, Academy vice president of governmental affairs. “Chairman Johnson’s bill is a good first step in that direction.”

The Johnson bill not only eliminates the SGR, but it also proposes a quality improvement program that appears to be consistent with a number of key guidelines on the issue that the Academy and the AMA developed with medical societies. The bill requires that the development of a value-based purchasing program for physician services contain the following: 

• Voluntary participation
• Allocation of new funds for payments to physicians who report and meet performance measures
• Evidence-based performance measured developed in a transparent, open process allowing each medical specialty society to have input
• Adjustments for variations in individual patient care and safeguards against patient de-selection
• A phased-in program
• The ability for physicians to review,  comment on and appeal performance ratings, as well as a requirement that physicians’ comments be released along with their rating

However pleased with the bill, the Academy is concerned about the tight implementation timetable in the House legislation, although it is a more reasonable timeframe than the Senate Finance bill would allow.

“An implementation date of 2010 would be more realistic than the bill’s 2009 date for a value-based purchasing program that rewards physicians based on the actual score on the measures,” Cohen said. A reasonable phase-in process, including a practice period for physicians prior to the start of “value” scoring, is critical to allow thorough testing of the measures in multiple settings and patients to avoid unintended consequences that might affect the poorest and sickest of patients.