Proposed changes to the Physician Quality Reporting Initiative, the CMS' effort to aggregate claims-based quality data and reward the physicians who submit them, are meeting with no small amount of skepticism among doctors.
Physicians doubt value of PQRI changes
“To be honest, I think CMS is struggling to make this program work when it has been clunky at best,” says Bruce Bagley, M.D., medical director for quality improvement for the American Academy of Family Physicians. “They've had a hard time making claims-based reporting work and so now they're trying to emphasize registries and electronic health records. They're heading in the right direction, but a lot of physicians are still not equipped.”
One of the biggest issues up to this point, according to the CMS, has been the large number of physicians who participated in the voluntary program using claims-based reporting, but who failed to qualify for bonus payments. In both 2007 and 2008, only about half of the eligible professionals who submitted claims-based quality data actually qualified for payments, the CMS said in the proposed rule.
Family physicians' confidence in claims-based quality reporting was shaken after AAFP then-President Jim King, M.D., championed the program to members, submitted quality data in his own practice, but subsequently failed to receive a bonus, Bagley says.
To make claims reporting easier, the CMS has proposed lowering the reporting threshold from 80% of applicable cases to 50% for 2011—a move that “could substantially increase the portion of participating professionals who qualify for the PQRI incentive,” a CMS spokesman said in an e-mail. The revisions appeared in the proposed changes to the Medicare physician fee schedule, published late last month. The CMS is accepting comments on the proposed rule until Aug. 24, with a final rule expected by Nov. 1.
But the changes will do little to fix a burdensome program that promises little or no return, says Brian Bachelder, M.D., a physician and assistant faculty member in the Center for Family Medicine at 490-bed Akron (Ohio) General Medical Center. The government offers no recourse for review when physicians don't qualify for bonuses, Bachelder says, and because there is no feedback mechanism, they often don't know what they did incorrectly.
Despite his sentiments about the program, Bachelder participates in PQRI because his hospital requires it. “I fill out the forms because we have to, but I never expect to get anything from it,” he says. “I've actually never talked to anybody who has gotten a check.”
Many physician associations and advocacy groups are urging their members to steer clear of the error-prone, claims-based reporting mechanism altogether and to instead put their energy and resources into qualified registries or EHR-based reporting. Clinical registries collect data from their users and report performance directly to the government or other organizations.
Brian Whitman, associate director of regulatory affairs for the American College of Cardiology, says the group has been telling members to focus on clinical data registries because they pretty much guarantee a bonus check. In fact, according to the CMS, more than 90% of providers who submitted using registries received their incentive payments. Registries also provide immediate quality data that can be used to improve care, Whitman says.
Lowering the reporting threshold might motivate some physicians to get onboard, but far more will be driven by looming financial penalties for inaction, says Robert Bennett, a government affairs representative with the Medical Group Management Association. The Patient Protection and Affordable Care Act mandated staggered PQRI incentive payments over the next four years—1% of estimated Medicare Part B charges for all covered services in 2011, and 0.5% for years 2012 through 2014. Eligible professionals who don't participate in the PQRI will begin to incur financial penalties in 2015.
“Our office has seen an increase in interest in beginning to participate in 2010, and we've been reminding members about the 2010 half-year PQRI, which started July 1,” says Bennett, who explained that physicians have the option of two reporting periods—one that runs all year and another that begins in July and ends Dec. 31. “We're not urging them one way or another, but we are giving them the success and failure rates of the different reporting mechanisms so they have an informed position.”
In addition to tweaking claims-based reporting requirements, the CMS also proposed making 12 new measures available for EHR reporting, which would bring the total number of PQRI measures available for EHR-based reporting to 22. The 12 additional measures overlap with quality measures included in the American Recovery and Reinvestment Act of 2009, marking the CMS' first steps to align the PQRI program with the meaningful-use requirements outlined in the stimulus law. They include measures related to childhood immunization status, hypertension and body-mass index.
“The synergy between the two programs and the stiff deadlines are designed to push us forward fast,” Bagley of the AAFP says.
The CMS proposed adding 20 new PQRI measures, many of which can be reported on via registries. They include measures related to risk-adjusted functional status for a range of physical impairments, patient-care transitions and smoking cessation.
The CMS also proposed expanding the group practice reporting option to allow practices with fewer than 200 eligible professionals to report.
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