September 18, 2006

Dear Members of Congress:

As leaders in the patient advocacy community, we are writing urge your support for a number of important issues affecting patient care and quality. We understand that Congress is currently developing legislation to fix the Medicare payment formula for physicians. It is important that several key provisions be included in that legislation in order to assure patient access to needed medical technology and improve the quality of health care for Medicare beneficiaries.

H.R. 5369, The Medicare Clinical Laboratory Fee Schedule Improvement Act, would establish a low-cost demonstration program to help ensure Medicare patients and their physicians have access to the latest molecular diagnostic tests and make other improvements in the lab test fee schedule. Molecular diagnostic tests are cutting edge medical technology that is critical to the development of personalized medicine, and to more accurate and more timely diagnosis and treatment of cancer and other dread disease. Unfortunately, the current system of paying for lab tests is so antiquated that it discourages development of these tests, which did not even exist when the current Medicare fee schedule was developed in 1984.

S. 2022, the Remote Monitoring Access Act, would expand access to health care services for many Medicare beneficiaries. This bill enables patients with chronic illnesses and their physicians to effectively manage their diseases without having to leave their homes. Remote monitoring reduces office visits and has been shown to improve quality of care and reduce hospitalizations and other complications. Medicare’s current reimbursement rules will pay for a physician visit to monitor these diseases, but does not reimburse physicians for the remote monitoring that would avoid the visit and provide more effective health care. This legislation would correct these backward incentives by directing the Secretary of Health and Human Services to develop a payment system for physician participation in remote monitoring.

Any physician fee fix is likely to be accompanied by further steps toward value-based purchasing, also referred to as pay for performance. Patients strongly support incentives to improve the quality of care for Medicare beneficiaries. However, previous value-based purchasing proposals have also included incentives for “efficiency” in provision of care. Patients are concerned that, without proper safeguards, authority for efficiency reimbursement could become a blank check for a “cheapest is best” approach to care that would limit patient access to needed care and inhibit medical progress.

If the physician fee formula change includes an authorization to establish efficiency measures in Medicare, it is critical that it include at least the following key principles:

• Standards must be set by a fair, open, and transparent process involving patients, providers and manufacturers.
  
  
• Standards must be based on the recommendations of the relevant medical specialty societies or a consensus of the peer-reviewed literature.
  
  
• Efficiency standards must measure both cost and quality, not just cost. Providers judged efficient must provide care that is both low cost and high quality.
  
  
• Quality must be measured by the outcome of an appropriately defined episode of care, not just by process measures that, by definition, cannot be a complete measure of the quality of care provided.

Thank you for your consideration of our views.

Sincerely,
American Association of People with Disabilities
Interstitial Cystitis Network
Kidney Cancer Association
Society for Women's Health Research
Sudden Cardiac Arrest Association
WomenHeart