MINNEAPOLIS, December 3, 2009 – The Minnesota Medical Association generally agrees with the AMA’s analysis of the Senate health care reform bill but parts ways with the AMA on its decision to oppose a provision that would require Medicare to establish a value index for paying physicians.

On Wednesday, the AMA released its analysis of the Senate bill HR 3590 in a letter to Senate Majority Leader Harry Reid.

At this time, the AMA is neither supporting nor opposing the entire bill. But instead has identified what parts of the bill it supports and opposes.

The AMA supports the implementation of health insurance reforms, creating a health insurance exchange, enhancing Medicaid coverage to expand the nation’s health care safety net, implementing prevention initiatives, and establishing an independent comparative effectiveness research entity.

The AMA has also said the bill should include a permanent fix of Medicare’s broken SGR formula.

The AMA also called for the Senate to remove the parts of the bill that would

• create an Independent Medicare Advisory Board that has the power to mandate payment cuts to physicians,
• provide new primary care bonus payments offset by reducing payments to other physicians,
• enact a 5 percent tax on elective cosmetic surgical and medical procedures,
• penalize physicians who do not participate in the Physician Quality Reporting Initiative,
• prohibit physician-owned hospitals,
• and institute a Medicare provider enrollment fee for physicians.

Medicare and value-based payment
The AMA also opposes the bill’s call for the creation of a value-based payment modifer that would begin rewarding physicians who provide high-quality, low-cost care and help address the current Medicare payment disparities that exist between states.

For months, the MMA and members of Minnesota’s Congressional delegation have been advocating for such a modifier. The MMA has been a strong supporter of Sen. Amy Klobuchar’s and Rep. Betty McCollum’s efforts to ensure the inclusion of Medicare payment reform in the final reform package.

The current Senate bill requires the development and application of a value index modifier that would base a portion of Medicare payments on the quality of care provided compared to the cost of that care.

The AMA says in its statement that there is no way to currently do this and the Centers for Medicare and Medicaid Services lacks the resources to develop such a method. Therefore, it calls for more study, rather than a commitment to redistribute Medicare payments based on cost and quality outcomes.

The MMA agrees that any value-based payment system needs to be valid, accurate and verifiable, but disagrees that the nation should wait for the perfect system before attempting to address the current situation that penalizes high-quality, low-cost, states such as Minnesota.

“We have been saying since the federal reform debate began that if we fail to reform the flawed Medicare payment system, we will have failed,” said MMA President Benjamin Whitten, M.D. “We all agree that we need to move to a system the rewards quality and this value-based payment language starts us on that path.”

The MMA will continue to communicate our support for the value-based payment language to our two U.S. Senators and we will inform the AMA that they need to get on board. “The reality is that the current bill has a lengthy timeline that will allow for CMS to develop a workable solution,” Whitten said.