Statement from American Medical Group Association (AMGA) Regarding Release by Provider Utilization and Payment Data

Released: 11-Apr-2014 11:00 AM EDT
Source Newsroom: American Medical Group Association (AMGA)
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Newswise — Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released the data set, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (Physician and Other Supplier PUF), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals.

Donald W. Fisher, Ph.D., CAE, president and chief executive officer of the American Medical Group Association (AMGA), made the following comment:

The CMS data linking Medicare reimbursements to specific practitioners, released yesterday by the Department of Health and Human Services (HHS), has focused attention on the deficiencies of the current Medicare reimbursement system. These reimbursements are based on the current logic of paying by Fee for Service (FFS) – the more care you provide, the more reimbursement you get. Thus, the FFS payment system established incentives that, without accountability and team-based care, can lead to fraud, waste, unnecessary care, and abuse in the Medicare program. Although the public should be cautious about interpreting this data without full contextual information, the release of the data presents a valuable opportunity to reexamine our reimbursement system.

For years the American Medical Group Association (AMGA) has been advocating for a change in the American health care system to the coordinated care model practiced by multispecialty medical groups and other organized systems of care through value-based payment arrangements, such as Accountable Care Organizations and Medicare Advantage. In this model, care delivery and reimbursement are tied to quality metrics, and not on the volume of encounters or administrative procedures. Thus, the care that is provided is necessary, relevant and timely. And, a reimbursement model based on quality and efficiency is transparently accountable, minimizing incentives for waste or abuse.

AMGA will continue to work with the HHS/CMS to help refine models of healthcare delivery that place a priority emphasis on the attributes of AMGA’s High-Performing Health SystemTM (HPHS). These attributes include efficient provision of services, organized systems of care, quality measurement and improvement activities, care coordination, use of evidence-based medicine and health information technology, accountability and transparency, patient engagement, and compensation practices that are affiliated with all these attributes. We believe that through the HPHS, we will be able to achieve outcomes―and measurable data―that will ensure that health care quality is improved for all Americans.

About American Medical Group Association
The American Medical Group Association (AMGA) represents medical groups and organized systems of care, including some of the nation's largest, most prestigious integrated health care delivery systems. More than 150,000 physicians practice in AMGA member organizations, providing health care services for 120 million patients (nearly one in three Americans). Headquartered in Alexandria, Virginia, AMGA is the strategic partner for these organizations, providing a comprehensive package of benefits, including political advocacy, educational and networking programs, publications, benchmarking data services and financial and operations assistance. For more information, visit www.amga.org or call (703) 838-0033.


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