Medicare pay-for-reporting still gets bad grades from physicians

Washington -- Now in its fourth reporting year, Medicare's Physician Quality Reporting Initiative continues to frustrate physician practices that are looking to access feedback reports from past years and use them to improve their patient care, according to research released Feb. 17 by the Medical Group Management Assn.

MGMA surveyed practices representing more than 11,000 physicians and found that fewer than half were able to access their PQRI feedback reports from the 2008 reporting year. That's a decline from the 51% who successfully obtained their reports for 2007, the first year of the program. And 60% of practices that were able to access their 2008 reports were either dissatisfied or very dissatisfied with the information.

Compared with the approximately five hours it took to download the 2007 PQRI feedback reports, on average it collectively took almost nine hours by practice staff and physicians to download the 2008 reports, MGMA found.

Moreover, the practices that do persevere in navigating the time-consuming download process find that the information is too complex and outdated to be much good in helping with quality improvement.

"There is difficulty in understanding the feedback reports," said Robert Bennett, government affairs specialist at MGMA. "But the biggest issue here by far is that there's such a delay between when the practices report the PQRI data versus when they receive their feedback reports -- we're talking about 18 months."

The Centers for Medicare & Medicaid Services has increased the potential pay-for-reporting bonuses, expanded the number of participation options and increased the number of quality measures that practices can submit on their Medicare claims. But physicians said that unless people can understand the reports and receive them closer to the time they submitted the measures, the opportunity to improve patient care will be limited.

"PQRI reporting has no impact on the quality of care provided," said Keith Kriet, business manager with a dermatology practice in New London, Conn. "It merely adds an administrative requirement to document clinical best practices already part of our routine standard of care. As a consequence, it is a hindrance rather than something that helps."

The MGMA survey found that, more often than not, practices decided to participate in PQRI for the opportunity to obtain bonuses, currently set at 2% of all Medicare receipts for the 2010 reporting year. Many others participate because they suspect the voluntary Medicare program one day will become mandatory.

"I do not mind participating in PQRI," said Teresa Leidner, practice manager for Ridgewood (N.J.) Orthopedic Group. "Any extra revenue is helpful, and the threat of decreased revenue is a huge factor. However, the measures appropriate for orthopedics, in the office environment, do not improve the quality of care for the patient."

Improving the process

MGMA maintains that for the PQRI truly to improve patient care, it should provide more timely and actionable clinical information to physicians. Bennett said his organization is pushing CMS to get to a point where feedback reports are issued quarterly rather than annually.

Past American Medical Association research on the PQRI also has uncovered a large number of complaints about the processes practices use to access feedback reports and to find out if they reported enough measures to qualify for bonuses.

Medical practices have complained that they did not receive a PQRI incentive payment for a given year even though they insisted they had met all of the reporting requirements. CMS released 2008 results for the pay-for-reporting effort in November 2009, and even though more physicians participated and bonuses increased compared with the previous year, the successful participation rate for the program remained just more than 50%.

"It's important that the PQRI provide physicians with accurate, timely and meaningful feedback so that they can successfully participate and learn from reporting efforts that promote high-quality patient care," said AMA Chair-elect Ardis Dee Hoven, MD. "As a result of AMA advocacy, new improvements to the PQRI include the ability to access feedback reports via e-mail and view aggregate quarterly feedback reports by measure. More change is needed, and the AMA is working closely with CMS and the physician community to help make programs like PQRI beneficial to physicians and their patients."

CMS cites improvements

CMS officials said they have taken note of physician complaints, including those highlighted in the latest research from MGMA.

"Earlier input from MGMA and others brought these concerns to CMS' attention, and we have taken a number of steps to facilitate access to feedback reports and the content of those reports," said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

CMS sent an analysis to MGMA shortly after its research was published, highlighting some improvements in the PQRI program that were not noted in the organization's report. For example, MGMA's survey addressed only the process of accessing group-level reports from the PQRI Web portal, the agency noted. Because of the difficulty some physicians experienced in 2007, CMS established an alternate report delivery process for 2008 that allowed practices to call their Medicare contractors and have the reports e-mailed.

In addition, many physicians and group practices are now using registry-based reporting, which provides another option for feedback that presents fewer technical issues, CMS said.