Medicare pay-for-reporting targeted for improvement

Washington -- The government is working on improving the Medicare Physician Quality Reporting Initiative to make it more user-friendly, including expanding reporting capabilities from electronic medical records and physician groups. But for some practices, the program still has a long way to go to win them over.

The Centers for Medicare & Medicaid Services released 2008 data for the pay-for-reporting effort on Nov. 13, and even though more physicians participated and bonuses increased compared with the previous year, successful participation in the program remained just more than 50%.

More than $92 million in 2008 PQRI incentive payments were distributed to about 85,000 physicians this fall, with the average individual bonus coming in at about $1,000. But approximately 70,000 physicians who submitted data for 2008 did not qualify for any additional pay, even though many practices thought they did everything required.

"The system doesn't tell you if the code qualifies with what you have sent," said Adeline Hart, a medical coder and biller with a four-person ophthalmology practice in Tinton Falls, N.J. "You can't see what you did wrong. It just says that this is for reporting purposes only."

CMS does issue feedback reports to physicians, but they arrive only when payments are distributed, long after physicians have the chance to correct any reporting mistakes. The agency has said every participant gets a report, though some practices said they have not yet received any for 2008.

Hart said CMS should work toward issuing real-time or even monthly feedback reports, so a practice would have time to make corrections.

"There's no place to go for an answer," said Hart. "There's no follow-through. It shouldn't be this hard to do reporting."

Past surveys by the American Medical Association and the Medical Group Management Assn. uncovered a large number of complaints about the process practices need to use to access information about their PQRI payments and feedback reports. In addition to advocating for more expeditious feedback, the AMA is also pressing CMS to add an appeals process for those physicians who fail to qualify for bonuses and who feel that a detailed review of their participation is warranted.

The potential of registries

Physicians participating in PQRI in 2008 had the choice for the first time to report quality data through a qualified medical registry, which would then report that data on their behalf to CMS.

Only 8% of participants attempted to send their data via a registry. However, of that subset, 96% met the requirements for satisfactory reporting and qualified for an incentive payment. This accounted for 17% of the overall payments made for the 2008 program year. PQRI allowed reporting through 31 registries in 2008, increasing to 74 in 2009.

"There is a lot of potential in reporting PQRI information through registries. You can engage your registry all year long. Many can even provide interim feedback during the year. You can also engage your registry after the fact, when the year is done," said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

Some practices have heard about the registries but aren't sure how to connect with them. "Setting up with a registry requires more time and research, and it seems very confusing to me," said Janet Scoffield. She's the PQRI coordinator with a small dermatology practice in southwest Montana that consists of three dermatologists and a nurse practitioner.

Scoffield echoed the call for more timely feedback.

"We have no idea if our 2009 claims-based submissions will be successful because, apparently, there is no way to follow results -- only on the remittance notice where it states it's been entered," Scoffield said. "I didn't think there were any barriers to participation once we sorted out what measures applied to our practice."

Changes for 2010

Dr. Rapp said it is not feasible for CMS to generate real-time feedback reports, due to the amount of time it takes to process data received through PQRI. CMS does staff a help desk that can be reached via phone or e-mail, and payment disputes can be discussed with someone at the agency, he added.

CMS has expanded the number of national provider calls it schedules on PQRI. The agency has also added 12 educational resources to its Web site since the beginning of 2009, and it has added e-mail as one of the ways to receive feedback reports.

For 2010, CMS will begin accepting data from qualified EMR products for 10 individual PQRI measures. Physicians can count their submission of EMR-based measures toward their eligibility for an incentive payment. In previous years, such submissions were considered voluntary and did not count toward bonuses.

Effective Jan. 1, 2010, large practices of 200 or more physicians or other eligible professionals can submit quality information through a group option, which CMS anticipates will cut down on the number of physicians filing multiple reports on the same patient.

"One of the difficulties previously was the PQRI was limited to individual reporting, so physicians practicing in groups would sometimes have to report on the same patient, which could be duplicative," Dr. Rapp said.

The potential bonus payment for 2010 will remain at 2%, but the number of total available quality measures has increased to 179. The program is set to run through 2010 unless Congress extends it again.