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October 28, 2014 12:00 AM

Medicare's quality programs prove to be a hurdle, doc practices say

Andis Robeznieks
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    Gilberg

    An overwhelming majority of medical practices say they are already participating in internal quality-improvement processes, according to a Medical Group Management Association survey, but an even higher number said they do not believe participating in Medicare physician quality-improvement programs is enhancing their practice.

    According to a report on the findings released Monday at the MGMA's annual conference in Las Vegas, 82% of survey respondents were engaged in their own clinical-improvement effort, and more than 83% said Medicare's Physician Quality Reporting System, meaningful-use electronic health-record incentive program, and its Value-Based Modifier Program are distractions that impede quality improvement.

    Anders Gilberg, MGMA senior vice president of government affairs, said Medicare's programs have lost their focus and are not providing the promised timely, actionable feedback. Instead of quality-improvement programs, they have become bureaucratic data-reporting programs.

    "Physician practices are struggling mightily to comply," Gilberg said. "But the effort is not translating to higher quality of care."

    Gilberg also referred to the programs as "three silos with multiple penalties" asking physicians to report practically the same information in three different formats. The programs, which had previously offered small bonuses for compliance, switch to using punitive measures to gain compliance in 2015.

    Speaking at a "Washington Update" session at the conference, Jennifer McLaughlin of the MGMA government affairs department noted that harmonizing the reporting requirements for the three programs was "right up there" with repealing the Medicare sustainable growth-rate physician-payment formula as an MGMA priority.

    While acknowledging that Congressional gridlock was making passage of any legislation difficult, McLaughlin and Gilberg touted the bipartisan Flexibility in Health IT Reporting Act, sponsored by Reps. Renee Elmers (R-N.C.) and Jim Matheson (D-Utah), which would shorten the meaningful-use reporting period for 2015 from the full year to 90 days.

    McLaughlin said the programs were reaching a tipping point where the costs of participating were outweighing the benefits.

    The MGMA also issued another report Monday on the qualities that differentiate better-performing practices from the rest of the pack.

    Better-performing multispecialty practices monitor their operating costs, use benchmarks to assess performance, have less bad debt, and have more clinical-support staff, according the report.

    The report, based on survey responses from 2,518 respondents, noted that operating costs for better-performing practices made up about 56% of total revenue compared with about 70% for other groups.

    The top performers also had higher ratios of clinical support staff: 6.3 employees per full-time physician compared with 4.3 for the lesser performers.

    Todd Evenson, MGMA vice president of data solutions and consulting services, said this figure represents a "right-sizing" of sorts for practices' healthcare teams. The question practice managers must ask, he said, has changed from "Do I have enough people?" to "Do I have the right people?"

    Evenson also noted that 81% of better-performing practices are using patient-satisfaction surveys. "They're listening to their customers," he said.

    Follow Andis Robeznieks on Twitter: @MHARobeznieks

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