Medicare Compliance & Reimbursement

The AQA Alliance and Institute of Medicine call for more comprehensive quality control standards.

The Centers for Medicare and Medicaid Services (CMS) recently unveiled a new Web page offering further details on the Physician Quality Reporting Initiative (PQRI) authorized by President Bush on Dec. 20, 2006 in the Tax Relief and Health Care Act of 2006.
 
The PQRI represents a transition from CMS' previous Physician Voluntary Reporting Program (PVRP). The PQRI invites eligible professionals, including qualified Medicare physicians, therapists and other practitioners described in section 1842(b)(18)(C) of the Social Security Act, to submit appropriate quality-measure data on their Medicare claims, according to CMS.

For every service both reimbursable under the Medicare physician fee schedule and performed between July 1, 2007 and Dec. 31, 2007, reporting physicians will receive a bonus payment. Participants will receive an additional 1.5 percent of the price listed in the Medicare physician fee schedule, but those payments remain subject to an as-yet undisclosed cap.

The new CMS Web page includes a list of 74 quality measures. While 66 of those measures carried over from a Dec. 5, 2006 PVRP list, the list does include eight additions recommended by the AQA Alliance, a joint venture in healthcare quality control by the American Academy of Family Physicians, the American College of Physicians and America's Health Insurance Plans.

AQA suggested the adoption of these additional eight measures in January 2007. Because the final PQRI quality-measures list for 2007 will not be finalized until July 1, 2007 and the AQA plans to meet on May 30, interested physicians should check back for an updated list in June.

In addition to providing recommendations on the types of measures the PQRI should target, the AQA's Data Sharing and Aggregation Workgroup noted the limitations of the PQRI's voluntary approach. "The nation unfortunately lacks a uniform and coordinated strategy for aggregating physician or group-level performance data, which would enable us to effectively pinpoint gaps in quality and efficiency across the country," the Workgroup explained in their January 2007 report.

Because the PQRI's voluntary response format probably will not produce responses from those physicians or groups lacking in either quality or efficiency, the Workgroup advocates the creation of a national entity charged with constructing "uniform operating rules and standards for the sharing and aggregation of quality and efficiency data used in both the public and private sectors, for the purposes of performance measurement and reporting."

Just one year ago, the Institute of Medicine called for the creation of a "National Quality Coordination Board" in their December 2005 report on "Performance Measurement," and the Medicare Payment Advisory Commission's January 2007 report on Medicare Part B's implementation revealed similar concerns over the feasibility of standardized quality controls.

All three recommendations [...]