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Official: Reimbursement shouldn’t punish poor providers

Quality Improvement Monitor, September 15, 2005

Any new Medicare reimbursement system that adjusts payments based on quality shouldn't cut payments for below-average performances, an industry official said September 9.

And higher-performing providers should receive more than 1% or 2% in payment increases, Samuel Nussbaum, chief medical officer for the insurer Wellpoint, told a forum sponsored by the Medicare Payment Advisory Commission (MedPAC), Congressional Quarterly reported.

Nussbaum said reimbursement cuts to lower-performing providers would reduce the chances they purchase information technology systems, which could help improve care. Also, higher-performing physicians would need more than a 1% or 2% payment increase-a figure MedPAC has supported-to provide incentive, Nussbaum said.

Nussbaum suggested increases of 10% for primary care physicians and 5% for specialists. The increase would make up for differences in provider incomes, he said.

Nussbaum said a 2% increase might work for hospitals because their revenues are much greater than an individual provider.

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