Implementing the Physician Quality Reporting System in an Academic Multispecialty Group Practice

Berman, Bettina; Pracilio, Valerie; Crawford, Albert; Behm, William R.; Jacoby, Richard A.; Nash, David B.; Goldfarb, Neil I.

doi:10.1177/1062860613476733

Cited by 14 publications

(21 citation statements)

References 7 publications

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“…With the implementation of MIPS and a purported shift of practice of medicine from individual authority to societal accountability, the quality of medical practices continue to be under increasing and continuous scrutiny, not only by policy makers, but peers, payers, and patients (9,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The strategy developed by IOM in the early years to improve quality of care known as pay for performance or financial incentives to transform behaviors to achieve greater value substantially changed to PQRS and now quality measures as a component of MIPS (18,(33)(34)(35)(36). MIPS substantially altered PQRS measures with the ability to provide non-PQRS or non-MIPS measures to provide meaningful quality measurements.…”

Section: Quality Performance Measuresmentioning

confidence: 99%

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism

Manchikanti

2017

Pain Phys

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The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula – a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, “The Merit-Based Incentive Payment System, or MIPS.” The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), valuebased payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs). Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category

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Section: Quality Performance Measuresmentioning

confidence: 99%

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism

Manchikanti

2017

Pain Phys

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“…17 Preliminary results from the application of PQRS to individual physicians have demonstrated that the modest incentives (which were initially part of this program, but ended after 2014) are significantly offset by the implementation and maintenance costs of the program. 8 CMS recently reported that 76.9% of the 2889 neurosurgeons who participated in PQRS in 2013 were eligible for incentive payments, which averaged only $731. 11 Unfortunately, the majority of measures that are included in the traditional CMS-approved PQRS measure set are generic and process oriented, and concerns have been raised about their relevance to true clinical quality.…”

Section: Physician Quality Reporting System: Requirements For Satisfamentioning

confidence: 99%

The present and future of quality measures and public reporting in neurosurgery

Bekelis

McGirt

Parker³

et al. 2015

FOC

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Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare’s Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet “generic” quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control. The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs. Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care solutions, and actively participate in meaningful quality initiatives for the benefit of the patients served.

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“…They believe that they create additional administrative costs and are thus expensive to participate in. [2][3][4][5][6][7] They believe that they do not lead to quality improvement. 4,8,9 Nearly 84 % of physicians do not believe that Medicare quality reporting programs enhance their ability to provide patients with high quality care.…”

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional Assessment of the Quality of Physician Quality Reporting System Measures

Frankel

Bishop

2016

J GEN INTERN MED

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BACKGROUND: Starting in 2015, the Center for Medicare and Medicaid Services (CMS) requires all Medicare providers to report quality measures through Physician Quality Reporting System (PQRS) or incur a 1.5 % financial penalty. Research indicates that physicians believe this reporting does not lead to high quality care; however, little research has examined what PQRS actually measures, which is reflective of the physicians and patient disease populations being assessed. OBJECTIVES: (1) Identify the proportion of measures that apply to different medical specialties, types of quality measurement, and National Quality Strategy (NQS) priorities. (2) One hundred and ninety-eight and 254 individual measures, respectively, were analyzed by three domains: medical specialty measured, type of measure, and NQS priority category. KEY RESULTS: Between 2011 and 2015, the type of measures changed significantly, with fewer processes (85.4 % vs. 66.5 %, p < 0.001) and more outcomes (12.6 % vs. 29.1 %, p < 0.001). The measures showed no significant specialty or NQS category differences. For subcategories within each specialty in 2015, differences in measure type were statistically significant: surgery had the highest percentage of outcomes (61.1 %) compared to 21.7 % of internal medicine and 5.9 % of obstetrics/gynecology. For NQS categories, internal medicine had the highest percentage of effective clinical care measures (68.5 %), compared to 22.2 % in surgery. Surgery had the highest percentage of patient safety (31.9 %) and communication and care coordination measures (27.8 %) compared with internal medicine (5.4 % and 6.5 %). CONCLUSIONS: Our study shows that PQRS measures include many medical specialties and significantly more outcomes in recent years, particularly for surgery. PQRS still lacks sufficient measures for half of NQS priorities and sufficient outcomes to assess internal medicine and obstetrics/gynecology. CMS must continue to improve PQRS measures to better assess and encourage highquality care for all Americans.KEY WORDS: medicare; quality assessment; quality improvement; performance measurement; healthy policy.

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Implementing the Physician Quality Reporting System in an Academic Multispecialty Group Practice

Cited by 14 publications

References 7 publications

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism

The present and future of quality measures and public reporting in neurosurgery

A Cross-Sectional Assessment of the Quality of Physician Quality Reporting System Measures

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