Senator Norm Coleman's Medicare Payment Plan Questioned by CCHC

(St. Paul, Minnesota) - The "payment for performance" health care quality bill introduced by Senator Norm Coleman (R-MN), and partially adopted into the Senate Medicare bill concerns the Minnesota-based Citizens' Council on Health Care (CCHC).

"A Medicare payment for performance plan will inevitably lead to health care rationing, conflicts of interest between patients and practitioners, cookie cutter care, and the politicization of medicine," warns Twila Brase, president of CCHC.

GOVERNMENT-DIRECTED CARE
"Paying doctors and health plans in Medicare according to their performance essentially supports government directed medicine. It means that some official or group of officials outside the examination room will determine what constitutes a good performance in health care quality and what does not. Patients will have no say in the matter," says Brase.

The Senate Medicare bill (S.1) includes a portion of Senator Coleman's "Medicare Payment for Quality and Value Act of 2003" (S.1257). It requires the Institute of Medicine (IOM) to "conduct an evaluation of leading health care performance measures and options to implement policies that align performance with payment under the medicare program."

Not included in the bill passed by the Senate was Sen. Coleman's second proposal: to establish payment for performance demonstration projects. Under the projects, HHS would have increased payments to health care providers in low-cost high-quality States "that demonstrate adherence to quality standards identified by the Secretary..."

POLITICIZATION OF MEDICINE
"Although the aim is health care quality, this pay for performance initiative will bring health care decision-making into the cubicles of government and the halls of Congress. That's about as far from the patient's bedside as you can get," Brase says.

"To secure better payment, doctors will be tempted to treat patients - not according to their specific needs - but according to the government's performance measures," Brase says. "Political power will also come into play as various practitioners, and pharmaceutical and medical technology companies, vie for a place in the approved quality performance measures."

COOKIE-CUTTER MEDICINE
"Quality health care requires that medicine be customized to meet the needs of individual patients. We fear that Senator Coleman's pay for performance initiative may lead instead to health care rationing and standardized cookie cutter medicine for our senior citizens," Brase explains.

"While Senator Coleman has been diligently working in Washington DC, many voters have hoped that his efforts would be directed toward protecting patient interests. Patients want doctors who are committed to delivering quality health care that meets the patient's standards for performance, not the government's," says Brase.

"Our hope is that Senator Coleman will rethink his initiative and modify it to ensure that it is in fact patient-centered," Brase adds.