WASHINGTON - Amid industry concerns, a new pay-for-performance program has been outlined by the Centers for Medicare & Medicaid Services. The voluntary 2007 Physician Quality Reporting Initiative (PQRI) will reward physicians for their performance on 74 measures. These include aspects of treatment and screening for Medicare patients with diabetes, heart disease, depression, stroke, glaucoma, cataracts, osteoporosis, melanoma, end stage renal disease, asthma and pneumonia.
According to a law passed last December, doctors who measure and report their performance from July 1 to December 31 of this year based on the measures may receive a bonus payment of 1.5 percent of their total allowed charges under Medicare.
The bonus is subject to a cap, partially determined by a formula that hinges on how many times a provider reports. Physicians who report on the measures with greater frequency are less likely to be capped, the spokesperson said. Accordingly, only physicians who already meet a certain threshold for quality reporting are eligible to participate in PQRI.
Medicare officials have made it clear that though physician pay-for-performance (P4P) is only in the voluntary stages now, CMS may one day make it a permanent aspect of Medicare.
“We’re moving towards value-based purchasing in all of our payment systems and we’re working with Congress to accomplish that,” a CMS spokesperson said. “We want to transform Medicare from a passive payer to an active purchaser.”
CMS Acting Administrator Leslie V. Norwalk has said that CMS “is committed to becoming an active purchaser of high quality, efficient health care, and the PQRI program is an important step in that transformation.”
Some healthcare stakeholders have expressed concerns over what seems to them like an ambitious and complex P4P model. Chris Weiss, president and CEO of Dynamic Clinical Systems, Inc., said he is encouraged to see signs of CMS’s progress, but remains skeptical as to whether clinicians at both smaller and larger institutions will be able to accurately measure, track, and report on the breadth of the measures.
“Certainly, without the help of robust healthcare IT, smaller offices will have no practical way to either stay abreast of the measures or to address them in an efficient way,” Weiss said. “The net impact will be to continue to keep too many clinicians and their patients on the sidelines.”
Joseph I. Bormel, MD, chief medical officer of the QuadraMed Corporation, said the measures may be tough to collect and good results might be difficult, but they are “highly appropriate” and only underscore the critical role of an effective EHR.
“However, there should be a commitment on the part of government to a policy leading to P4P only after providers have been given a reasonable opportunity to implement technology that effectively enables them to provide proof of performance,” he said.
The CMS spokesperson said that, while there is a learning curve, PQRI is in fact fairly simple. Providers need to devise a strategy for reporting over the six month period and then report the quality codes for the procedures.
At a webinar last December, Thomas B. Valuck, MD, a CMS medical officer and senior advisor said CMS is searching for the sweet spot that might entice more doctors to participate in P4P.
“CMS is currently analyzing what the ultimate amount would be to engage the majority of physicians in voluntary participation,” Valuck said. “The 1.5 percent incentive is just a start. It could take as much as 20 percent to motivate physicians.”