Medicare launches voluntary quality reporting system

The program will not affect physician reimbursement to start, but the CMS chief hints that Congress could change that.

By David Glendinning — Posted Nov. 14, 2005

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Washington -- Whether or not Congress acts on physician pay-for-performance before the end of the year, Medicare officials soon will be giving doctors a chance to have a taste of what's to come.

In January 2006, the Centers for Medicare & Medicaid Services will implement the Physician Voluntary Reporting Program. Physicians will be able to report how well they fare on 36 quality measures chosen in collaboration between CMS and various physician organizations, including the AMA Physician Consortium for Quality Improvement.

For example, doctors who choose to participate can report to the government on whether they conduct osteoporosis screenings for elderly female patients or whether they administer beta-blockers to patients receiving coronary artery bypass grafts. CMS will set up special new G-codes for physicians to submit such clinical data along with their regular Medicare claims.

The program will be a major step in the move toward greater government support of high-quality health care, said CMS Administrator Mark McClellan, MD, PhD.

"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," he said in a conference call with reporters. "Through these voluntary reports by physicians on evidence-based consensus 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."

In the beginning, participation in the program will have no bearing on physician reimbursement, and the quality data submitted by doctors will not become publicly available. Instead, CMS starting next summer will let individual physicians know how well they fared on the quality measures that they reported.

But upcoming Medicare rate cuts that Congress is working to rescind still loom large for physicians and present a major barrier to such health care improvement efforts, said American Medical Association President J. Edward Hill, MD. Absent congressional intervention, an estimated cut of 4.4% will kick in Jan. 1, 2006, that will further squeeze physicians financially and prevent many of them from committing resources to the new effort, he said.

"Physicians are dedicated to quality improvement, but without action to halt the Medicare physician payment cuts, new physician reporting measures will gain little traction," Dr. Hill said.

Dr. McClellan conceded that few physicians are likely to participate in the quality reporting initiative right out of the gate. When Medicare launched a similar program with hospitals in 2003, several months went by with less than 10% of hospitals sending any quality data to the government for analysis.

Compiling the data for the new G-codes also will present an administrative burden to many physician practices. In many cases, reporting quality data with a minimum of additional practice costs would require the use of electronic health records, Dr. McClellan said.

Voluntary (for now)

Despite the potential hassles, the Physician Voluntary Reporting Program might benefit participating doctors by preparing them for the future, according to CMS.

Congress continues to debate physician pay-for-performance measures that would stake up to 2% of doctors' reimbursements on how well they meet certain yet-to-be determined quality measures. CMS has designed the new program as an interim step toward achieving such a goal -- and one that could factor into what kind of value-based purchasing plan emerges from Capitol Hill.

The fact that the 36 initial measures will have no impact on reimbursement in the beginning does not mean that they never will. CMS has not ruled out the possibility of increasing administrative payments to doctors who participate to offset their data reporting costs.

The hospital quality reporting initiative started out as a completely voluntary exercise, but poor initial interest by hospitals prompted Congress and the Bush administration to reduce facilities' Medicare pay by 0.4% if they failed to participate. Dr. McClellan suggested that lawmakers and federal officials could follow a similar path with the physician program.

"Congressional involvement in tying this into our payment system could make a big difference," he said. The CMS chief declined to rule out the possibility that Congress could alter the voluntary program in time to affect doctor pay for at least part of 2006.

Even if lawmakers don't add a financial incentive to the new voluntary program, reporting on the measures will be good practice, Dr. McClellan said.

"Physicians may want to participate, because there's clearly a trend -- not just in Medicare but throughout our health care system -- toward a greater emphasis on quality rather than simply volume in payment, and those who participate early can get a leg up on working well in that kind of reformed payment system," he said.

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Getting into the habit

Starting in January 2006, doctors who participate in Medicare's new Physician Voluntary Reporting Program will report how well they do on quality measures developed by the government. Here are six of the 36 initial measures.

  • Beta-blocker therapy for patients with prior myocardial infarction
  • Hemoglobin A1c control for patients ages 18-75 with type 1 or type 2 diabetes
  • Screening of elderly patients for falls
  • Smoking cessation treatment for patients with chronic obstructive pulmonary disease
  • Mammography
  • Antibiotic prophylaxis for surgical patients

Source: Centers for Medicare & Medicaid Services

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External links

Fact sheet from the Centers for Medicare & Medicaid Services' Physician Voluntary Reporting Program (link)

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