Medicare Compliance & Reimbursement

CMS tries to assuage docs before tying quality reporting to Medicare payments.

Quality improvement initiatives could doctor up the health care industry for patients and providers alike--but only if physicians are willing to participate.

The Centers for Medicare & Medicaid Services is changing the way it reports quality care to Medicare beneficiaries by revising its Physician Voluntary Reporting Program--and this time, the medical community is showing signs of satisfaction.

"Under the voluntary reporting program, physicians who choose to participate will help capture data about the quality of care provided to Medicare beneficiaries, in order to identify the most effective ways to use the quality measures in routine practice and to support physicians in their efforts to improve quality of care," maintains CMS. Participation in the revised PVRP will begin later this month.

PVRP Struggles To Overcome Harsh Criticism

CMS originally announced a more ambitious and elaborate PVRP in October 2005--the same day it announced a 4.4 percent physician payment reduction. The payment cut went into effect Jan. 1, 2006, although pending budget reconciliation provisions may yet reverse it. The irony of the dual announcements wasn't lost on the medical community, which responded to the PVRP with harsh criticism.

"[The plan] would increase physicians' administrative costs in an already negative payment environment," charged the American Academy of Family Physicians. "The Academy always supports efforts for quality," noted AAFP president Larry Fields, M.D., "but this program is overly burdensome and probably unworkable ... it will be a paper-and-pencil, labor-intensive effort. Even though it's voluntary, it will be cumbersome."

In addition, the American Medical Association urged CMS to rescind the plan altogether, expressing frustration that CMS expected physicians to voluntarily take on a new reporting obligation when it was "unwilling" to provide an administrative fix to the "flawed" sustainable growth rate.

A Phased-In Approach Aims To Encourage Provider Participation

Instead of rolling out all 36 quality improvement measures outlined in the October 2005 PVRP, CMS will begin the revised program in January with a phased-in, 16-measure "core starter set." This prioritized starter set, which received National Quality Forum and Ambulatory Care Quality Alliance endorsement, is in line with feedback from physician organizations, including the American College of Physicians. Quality Improvement Organization programs will use the starter set in the QIO's eighth scope of work.

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. Participants will receive confidential reports from CMS [...]