A congressional advisory body's proposal to financially reward physicians based on certain clinical performance measurements received mixed reviews on Capitol Hill this week.

During a House Ways and Means subcommittee on health meeting Tuesday, experts told Congress that a recent proposal from the Medicare Payment Advisory Commission to reward physicians based on performance measures, which include "functions of IT systems that are linked to quality improvements," is a good idea. But an official from the Society of Thoracic Surgeons said parts of that recommendation could have drawbacks for physician practices. Jeffery Rich, MD, chairman of the Society for Thoracic Surgeons' task force on pay-for-performance, said MedPAC's recommendation to use an across-the-board reduction from all physician fees to create a bonus pool is a mistake.

"Physician practices are very different than hospital systems in terms of their readiness and ability to purchase needed technology," Rich told House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.). "Reducing physician fees would not be the positive incentive needed for investment in new systems."

The Pacific Business Group on Health is part of a program that bases some of its rewards to physicians on investment in and adoption of IT. Peter Lee, president and CEO of the group, said such programs "reinforce the rationale behind the MedPAC proposal to start with rewarding information technology capacity and then phase in performance rewards for quality, patient-experience and cost-efficiency…"

The Society for Thoracic Surgeons' Jeffrey Rich agreed that creating incentives for physicians to collect data, eventually through electronic health records, "is the cornerstone of quality improvement." He said these improvements are best accomplished by providers developing relevant measures, which would be collected through participation in a database. Rich called for a national demonstration project to evaluate the effectiveness of incentives on participation in the Society of Thoracic Surgeons' National Cardiac Database, which contains outcomes on cardiothoracic surgery.

Rich said STS database participants pay an average of $50,000 per practice to submit and analyze clinical data and do not get reimbursed for these costs.

"Facing larger than 5 percent fee reductions each year, physician practices are not in a position to invest scarce funds in new technology. We believe that the answer to inappropriate care lies in performance measures based on clinical data created by each specialty. Compounding the inability to invest is the uncertainty brought by the lack of standards for electronic health records," he said.

Kenneth Kizer, MD, president and CEO of the National Quality Forum, also testified Tuesday. Kizer predicted that modern IT tools and the use of electronic health records would help facilitate quality improvement. "Basically, it provides an easy and reliable means to document and assess performance," he said.