Medicare Compliance & Reimbursement

CMS phasing in measurements to aid performance improvement.

With lackluster Medicare reimbursement plaguing physicians nationwide and lawmakers trimming federal health care programs' already meager funding, one new federal program may provide a win-win solution to both health care providers and Medicare.
 
On Oct. 28, the Centers for Medicare and Medicaid Services initiated its Physician Voluntary Reporting Program for Medicare-a move the agency insisted will ease physicians' difficulties in reporting consensus quality measures.

The overall objective of the PVRP is to help physicians obtain information they can use to improve quality and avoid unnecessary costs. In the first phase of the program--beginning in January 2006--Medicare will enable physicians to voluntarily report information to CMS about the quality of care they provide to Medicare beneficiaries using 36 evidence-based measures.

The agency will then provide feedback to participating physicians on their level of performance based upon the data they submit. This feedback may begin as early as summer 2006.

Another of the program's objectives is to increase the effectiveness of how the government compensates physicians for providing services to Medicare beneficiaries, while avoiding increases in overall Medicare costs. "Physicians are in the best position to know what can work best to improve their own practices and ultimately the quality of care available to all patients," CMS administrator Mark McClellan said in a statement. "Through these voluntary reports by physicians on evidence-based quality measures, we can take an important step together to help them improve care, and ultimately to help make sure that they are adequately compensated for that care."

During the plan's first phase, CMS will begin collecting information using a dedicated set of Healthcare Common Procedure Coding System codes, called G codes, which will supplement the claims data doctors currently submit to CMS with clinical data.

The agency will then use this clinical data to measure the quality of services that physicians provide to Medicare patients. CMS anticipates that these G-codes will serve as an interim step until data submission through electronic health records replaces this process.

By the summer of 2006, the agency will provide feedback to the participating physicians about the level of their performance based on the data they submitted. The goal is to use this feedback to assist physicians in improving their data accuracy, reporting rate and clinical care.

CMS will also seek input from participating physicians on ways to make reporting data easier and the quality measures more useful, such as by promoting reports and analysis through electronic medical record systems.