Pay for Performance, More Data Collection Could Be the Future for Doctors, Hospitals
CMS is moving away from covering devices or therapies that will aid only a small population.
During yesterday’s HHS Town Hall Meeting, Steve Phurrough, MD, MPA, Director of Coverage and Analysis at the Centers for Medicare and Medicaid Services, offered some insight into issues before the agency.
Phurrough gave an overview of CMS initiatives on coverage, payment, quality and transparency, reiterating the need for change on all fronts.
Pay for performance
According to Phurrough, many larger institutions are already operating in a pay-for-performance environment. Hospitals are now required to report more information on patients to CMS. In addition, CMS is looking to require more data collection for patients and to require device tracking. The aim is to understand which devices and treatments work for specific patient populations.
Cardiologists, however, are concerned about the criteria that CMS will consider when measuring performance. Gregg W. Stone, MD, CRF Chairman and a Professor of Medicine at Columbia University Medical Center, moderated the session. Stone questioned Phurrough specifically about older patients who have a small chance of survival regardless of treatment and how that would affect CMS’ consideration of physician performance.
Many gray areas exist regarding performance level when applied to specific situations, Phurrough acknowledged. He suggested a CMS committee could specifically assess such cases. Meanwhile, he emphasized the need for cardiologists to update patient charts to accurately record diagnoses.
Another possible area of contention for CMS and cardiologists deals with clinical trials. CMS is concerned that some trials may be narrowly defined to evaluate a specific population.
This makes it difficult for CMS to generalize data to assess the overall population’s need for the device or therapy under study. The ability to generalize information, in turn, influences coverage, according to Phurrough.
Greater good
This sparked some controversy as Stone explained that the inherent design of clinical trials begins with a specific patient group. As a device moves through the clinical trial process, the population that is studied inevitably broadens.
Phurrough said that CMS is interested in “the greater good for the general public” and said that the agency is moving away from covering devices or therapies that will aid only a small population.