WASHINGTON – As Congress and the Centers for Medicare and Medicaid Services (CMS) move forward to implement pay-for-performance (P4P) or “value based purchasing,” ophthalmology is well positioned should it choose to participate. At last week’s House Ways and Means Health Subcommittee hearing on “Medicare Value-Based Purchasing for Physicians’ Services Act of 2005” (H.R. 3617), CMS Administrator Mark McClellan, MD, indicating his commitment to establishing some form of pay for performance (P4P), with or without legislation, announced that the agency will initiate a voluntary quality reporting system for physicians next year. Without legislation to provide funding, the 2006 program may not include additional compensation for participating physicians.

The Academy stepped up the development of quality measures for ophthalmology in early 2005 in response to congressional calls for physicians to take a leadership role. Its long range goal is to have ophthalmology ready to compete for any additional monies that may become available in a new P4P payment system. The Academy initiated a process to actively engage ophthalmic specialties in the effort, which resulted in eight performance measures for ophthalmology. It was, therefore, pleased that at the hearing McClellan distributed the list of all CMS accepted clinical measures, including six ophthalmology measures (more than any other medical specialty), selected from the original eight submitted by the Academy. CMS will convert the measures on the list to G-Codes, monitoring codes that are easily reportable on existing Medicare claim forms.

“With the measures in place, ophthalmologists can participate in the 2006 roll out of the voluntary reporting program if they choose to. The Academy has been out in front on this issue from the beginning. It has a long history of embracing the concept of quality standards as shown by the stature of our Preferred Practice Patterns,” said Richard L. Abbott, MD, the Academy’s secretary for quality of care & knowledge base development. “Fortunately, the Academy was able to facilitate a strong collaborative effort among the ophthalmic sub-specialties, which made development of the first set of measures for ophthalmology quick work. Because of our efforts, most ophthalmologists will not only have the option of participating in the reporting demonstration project, but will feel comfortable doing so.”

To further strengthen its leadership role and prepare for the next step in the P4P effort, the Academy has joined the National Quality Forum (NQF) and is working with the AMA Physician Consortium for Performance Improvement. The highly regarded NQF, created to develop and implement a national strategy for health care quality measure and reporting, is a forum for validating measures through its broad stakeholder membership base – health care purchasers, consumers and payors. The AMA Consortium is the leading physician-sponsored entity developing physician-level performance measures. 

The Academy also was consulted in the development of H.R.3617, the P4P legislation introduced by Subcommittee Chairman Nancy Johnson’s, R–Conn. The repeal of the Sustainable Growth Formula (SGR) has long been one of the Academy’s top priorities. The Academy has made it clear that any legislative attempt to create a new system that pays physicians based on some kind of performance must be linked to an SGR fix. Johnson’s bill is the first P4P legislation to meet that requirement.

“Our top priority is fair and reasonable reimbursement for ophthalmologists. The best way to achieve that is to be ready and engaged on all fronts – legislative and administrative,” said Catherine Cohen, the Academy’s vice president of governmental affairs.