Few doctors downloading Medicare resource use reports

Washington Physicians in four states have access to individual reports that measure the quality and costs of their care compared with other doctors treating Medicare patients, but large numbers of the doctors have failed to download the reports.

The Centers for Medicare & Medicaid Services has compiled individual quality and resource use reports for physicians treating patients in Iowa, Kansas, Missouri and Nebraska. WPS, the Medicare contractor for the jurisdiction, has emailed practices a web link to access the reports, but only 3,300 out of 23,730 had downloaded the reports as of the end of March.

Medical societies representing physicians in the four states are encouraging doctors to download the reports and provide feedback on the program. The reports detail per capita cost and quality reporting information in 2010 and give doctors a glimpse of how data will be used to adjust Medicare pay for some physicians under a value-based modifier that will take effect in 2015.

This is the third phase of the report card program. In 2009, CMS sent hard-copy reports to about 240 physicians. Electronic reports were available to more than 1,600 physicians and 36 medical groups in 2010.

In August 2011, the Government Accountability Office issued a report criticizing the initial stages of the program. Less than 10% of the electronic reports had been downloaded. The GAO encouraged CMS to do more to engage physicians and obtain feedback on the utility of the reports.

The American Medical Association is working with doctors to provide comments on the reports. Physician input is critical as CMS moves forward with plans to use 2013 Medicare claims to determine bonuses and penalties for selected physicians in 2015, said AMA President Peter W. Carmel, MD.

“We continue to have serious concerns that there are too many unresolved issues with these reports for CMS to use them to determine physicians’ bonuses and penalties for 2015, based on their scores in 2013,” Dr. Carmel said. “These issues must be resolved and physicians must be given enough time to transition to this system before the reports, which contain incomplete data, can be used to influence payment decisions.”

CMS has yet to determine which physicians will have the value-based purchasing modifier applied to their payments in 2015. The agency anticipates releasing a proposal this year on how the modifier will work, said CMS spokeswoman Ellen Griffith. The process will not involve additional Medicare funding, so some physicians deemed to be lower performers based on the quality and efficiency of their care will receive reduced payments so higher performing physicians can receive bonuses.

Individual physicians, particularly specialists, may not find the reports that valuable, said Michael Kitchell, MD, president of the McFarland Clinic in Ames, Iowa. For example, all reports provide data on 28 administrative claims-based measures that would apply mostly to primary care physicians. Dr. Kitchell is a neurologist, yet his report provided scores on how many of his patients received lipid profiles or mammograms.

Reports also note the average cost per patient while under a doctor’s care. That number could be low for some internists, but quite high for others treating patients with multiple chronic conditions in a hospital, Dr. Kitchell said.

“Many will look and say, ‘This is interesting stuff, but it is not my fault my profile of patients had low quality of care or high costs,’” he said. “Physicians are going to be upset with taking credit or blame for something they had no control over.”

But Dr. Kitchell does find value in the group practice version of the reports, which his clinic received in September 2011. Teams of physicians have more control over how performance is measured, he said.

“I live in a good medical neighborhood,” he said. “I’m happy to take credit for my primary care physicians doing the right thing and keeping costs down.”

The reports rely on data provided on claims through the Medicare physician quality reporting system, which also has had low rates of participation in recent years. One in four of the physicians receiving resource use reports had participated in PQRS by submitting quality data on claims in 2010, according to CMS.

The Medicare agency has used notices to encourage physicians in the four states to download the reports, Griffith said. This time around, very few doctors who have tried to obtain their reports have had access or download issues, which was a complaint heard during earlier phases of the program.