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Mr. PRICE of Georgia. I am so humbled by the participation of many of our physician colleagues in this hour on the floor of the House today. And Congressman Burgess from Texas has joined us, an individual who has great expertise in the health care arena, a preeminent member of the Energy and Commerce Committee, and has a wonderful perspective and has talked about this issue since his arrival in Congress and has put on the table specific solutions.

So I welcome him today and thank you for your comments.

Mr. BURGESS. Mr. Speaker, I thank the gentleman for his kind comments. Of course, the gentleman from Georgia has already done a great task with the posters this afternoon, but let me just reuse one that was seen a little bit earlier today.

This one tells such a great story, but unfortunately, it only tells a portion of the story. The year I took office was 2003. That means my last active year in practice was the year 2002, and missing from this graph, the year 2002, is a similar downward bar when doctors received the 5.1 percent what we euphemistically called a negative update. So the actual physicians' compensation for the 5- or 6-year moving budgetary window that we are all so fond of talking about has in fact been much less than is actually shown on this graph. And that is an important point to be made because, as we can see, all of the other aspects that deal with health care reimbursement once a year receive a cost of living, a market-basket update, but physicians' offices are expected to bear the brunt of cost reductions on a year-by-year basis.

As you so eloquently pointed out a few moments ago, that is unsustainable for any small business. If you are losing something on every transaction, you do not make it up in volume and stay in practice for very long.

One of the things that I think is so important that we discuss, we spend some time discussing this afternoon, as hopefully we get to a resolution of this problem in the conference committee that is now going on, is to talk a little bit about the pay-for-performance aspect of it. So much of the physicians' reimbursement is tied up in the talk of the pay-for-performance concept.

I would just like to submit that if we drive the best doctors out of providing Medicare services, if we really let the train run off the tracks on this, we will not be able to pay enough for performance in the future if we do not recruit our best and brightest to be the physicians of tomorrow, as Dr. PRICE has so eloquently stated, or if we drive out doctors who are in their mid-forties to their mid-sixties, doctors who are at the peak of their diagnostic abilities, the peak of their skills in the operating room. If these individuals stop seeing Medicare patients, we then make the whole system more expensive to administer if we have only the second and third tier of providers involved in that care.

Well, one of the things that we hear talked about is a pay-for-performance indicator, one that has the initials PVRP that stands for Physician Voluntary Reporting Program. Now, this is a program that is going to be articulated by CMS some point later in this year, and the reason I am concerned about it is we are being asked to accept the PVRP performance indicators as the standard against which we are going to judge physician practices for years to come, and we have not yet seen them in their totality. These are rules that will be put out by CMS some time later this year, perhaps April, perhaps May or perhaps June.

My understanding of the PVRP program is that it is largely a structural program and not necessarily outcomes-based. That is, does every diabetic receive a hemoglobin A1C test every so many months, rather than do we look

at the world of diabetic patients within this physician's care and make certain that the emergency room visits and the out-of-control hospitalizations are, in fact, in line with what would be expected.

Earlier this year, I introduced bill, H.R. 5866, to repeal the SGR formula in its totality, in order to acknowledge that there is a growing sentiment out there that some type of performance measure has to be built in. I did ask that the individual quality organizations that are already in place be allowed to provide voluntary guidelines for physicians to follow. These quality measures taken as a whole provide a balanced overview of the performance of an individual doctor or clinic or billing unit, if you will.

The whole idea was that they would be consistent; they would be relevant. They would be not overly burdensome time to collect and they would account for patient satisfaction. The goal of the system was fair assessment to reduce health care costs, improve health care outcomes, but very importantly, not contribute to the problem that we already have in this country of health care disparities in some communities.

Therefore, in order to account for the differences in patient population, health status and compliance, these formulas would need to be very tightly drawn.

In addition, there would be a measure reported back to the physician himself or herself as to how they did in comparison with their peer groups. These report cards, if you will, would not necessarily be made generally available to the public, but whether or not a physician or a clinic complied with the data that was required, would be made public.

I think it is important to give providers, to give clinics, to give doctors some measure of flexibility in this regard, and whether it be the participation in a medical home, whether it be the participation in the PVRP program, whether it be the participation in the national quality forum programs, that any of these should be seen as complying with the intent of the legislation to provide quality measures. They should be voluntary, and any increase in reimbursement should not necessarily be tied to the baseline of quality reporting, but an additional increase in reimbursement would be provided to those physicians and clinics and offices that did indeed provide some type of reporting data.

Again, I want to thank the gentleman from Georgia for bringing this very timely issue to the floor of the Congress. I do know there is a lot of work going on on this very issue right now, and my goal in this is to be helpful in the overall process and make certain that in the future we do not saddle physicians' offices and physicians' practices with additional reporting requirements that are not voluntary, that are mandatory, that are punitive in their nature and end up decreasing the overall quality and character of medicine that we have grown to enjoy in this country.

I thank the gentleman from Georgia.

Mr. PRICE of Georgia. Thank you so much for your perspective and for your wisdom in this area. It is extremely helpful and positive and productive for the debate that we are having or the discussion that we are having.