various quality reporting programs. (See “QRUR Resources,” opposite page.) From the data, Dr. Ragain saw his
group was approaching penalty terri- tory based on negative scores in qual- ity measures that discourage use of certain medications in the elderly. But that also meant he could pinpoint spe- cific areas to enhance care delivery. “There are all kinds of rationales
we use to not do what’s recommend- ed: Somebody may be on a drug for a while when they are not geriatric, but then they age into the group. Or the meds are working, so why mess with them? And it’s possible it’s right not to do what’s recommended. But gen- erally speaking, we know we have too many disease effects, and it leads to problems,” Dr. Ragain said. Once the group identified the gaps in care, “it was relatively easy to put a system in place around those metrics, and we were able to move out of the penalty box without a lot of focused work. Just like anything, if you set up a system to deliver that care, it works better than depending on individual memory.”
HELP, PLEASE As with many Medicare programs, however, the QRURs are “a step in the right direction, but [CMS] made it harder than it should be,” Dr. Ragain added.
The reports can be 20 pages long; CMS’ instructions can range up to 100 pages. Dr. Ragain also notes the QRURs
only show aggregate patient data, and physicians have to download and sift through separate Excel spreadsheets to drill down into how Medicare cal- culates their cost and quality scores. Even then, the information is at least a year old, “so you’re looking at your wake, not what’s in front of you.” And the quality data are easier to
interpret than the cost data, he adds. “That’s information we don’t have access to in our practice. We’re just rolled in [with other entities] and held accountable for things we don’t
manage,” making it difficult for prac- tices to understand which costs they are responsible for — versus hospitals or other practices, for example — let alone make adjustments to improve. As elusive is the process for access- ing the QRURs in the first place. A Harris County Medical Society (HCMS) study revealed significant in- efficiencies and redundancies in the CMS portals physicians must use to submit and retrieve their quality data. Under one gatekeeping system, for
example, physician groups must reg- ister and create an account and pass- word to submit their information to PQRS. The process can take 30 days, often requiring Internal Revenue Service documents. An entirely sepa- rate system exists for meaningful use reporting and Medicare enrollment. Delegating reporting tasks to staff re- quires lengthy registration processes. To retrieve a QRUR, physicians
must revalidate their security access in PQRS to get into a separate portal housing the reports. Doctors must
follow a similar process to get their PQRS feedback reports, which sit in a separate portal. Four HCMS physicians could not successfully report to PQRS in 2014 simply because they were unable to register on time. Houston neurologist and past HCMS President William S. Gilmer, MD, says demonstrating quality of care is complicated enough without added layers just to put data in and get data out. The solo physician and his staff spent 20 hours combing through 100-page CMS documents and calling helpdesks to figure out how to submit PQRS data via his EHR system. “I think I successfully submitted, but I still don’t know because CMS won’t tell me until fall of this year,” Dr. Gilmer said. He anticipates his QRUR will provide valuable insight into how his practice is faring, but he is not looking forward to slogging through the technicalities to find out. “It’s available to me. But the Medi- care rules and the tax code are avail-
PQRS PARTICIPATION ON THE RISE IN TEXAS
Year
2009 2010 2011 2012 2013
Participation Rate*
22.1% 25.7% 28.6% 38.9% 48.5%
*Includes physicians and other eligible health professionals Source: Centers for Medicare & Medicaid Services data and TMA research
July 2015 TEXAS MEDICINE 61
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