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President Bush signed an executive order on August 22 requiring any agency that administers a federal health program, including Veterans Affairs and Medicare, to adopt quality-measurement tools and uniform standards for health information technology. Neurologists who treat patients served by these agencies would need to adhere to the new standards.

By January 1, 2007, the agencies will be required to establish programs to measure the quality of care and cost of services, and to share that information with one another and with program beneficiaries.

The order also requires the agencies to adopt information technology systems that are interoperable. Health providers doing business with the government would need to purchase information technology products that meet that same standard for data sharing. They would also need to develop uniform methods of measuring and reporting the outcomes of treatments. Joel M. Kaufman, MD, Vice-Chair of the AAN Medical Economics and Management Committee, said the order will nudge physicians to adopt electronic medical records because reporting quality data is easier to do electronically than manually. But he questioned whether it is practical for these agencies to collect quality data from neurologists.

“For those who are not generalists, it will be difficult to define populations within a practice that can be compared accurately with others.” The order, he added, suggests that agencies could offer tiered insurance options to program beneficiaries depending on where they choose to receive care. So an insurer may have different premiums or co-payments based on a practice's quality or cost data.

“The data must be accurate, reflect the population of patients that a physician is caring for, and highlight true differences,” he said. “These programs must also ensure that physicians do not turn away more difficult cases in order to protect their profiles.” James Stevens, MD, Chair of the AAN Pay for Performance Work Group, said the order adds momentum to an initiative by Medicare to pay physicians according to their performance. He emphasized, however, that the government must explain what parameters will be used to determine quality of care under the executive order. An article on page 14 includes an interview with Dr. Stevens on AAN initiatives to develop pay for performance standards for neurology.