New Mexico patient for elective care. The New Mexico law has big impli-
cations for access to care in that state. According to the American Medical Association, the Eastern New Mexico counties of De Baca, Guadalupe, Hard- ing, Quay, Roosevelt, and Union have no cardiologist, no neurologist, no plastic surgeon, no orthopedic sur- geon, no radiologist, and no ear, nose, and throat doctor. Only Roosevelt County has an oncologist. Recent data from the New Mexico
and Texas departments of health show 13 counties in Southern and Eastern New Mexico send more than 22 per- cent of their hospitalized patients to Texas for care.
Physicians: CMS must improve PQRS feedback, review processes
PROBLEMS with the Centers for Medicare & Medicaid Services (CMS) feedback and informal review pro- cesses in the Physician Quality Report- ing System (PQRS) continue to plague physicians. The American Medical Association, the Medical Group Man- agement Association (MGMA), and 43 national specialty societies told CMS Acting Administrator Andrew Slavitt in a Feb. 9 letter (tma.tips/PQRSlet ter) that “the agency is merely adding red tape to an already administratively onerous program,” rather than driving quality improvement. The letter describes a multitude of
data errors by CMS and the agency’s mishandling of data submitted by phy- sicians who participated in the 2014 reporting period for the PQRS and value-based payment modifier (VBM) programs. It expresses concern “that physicians and group practices will be incorrectly penalized under the PQRS Program as a result of CMS’ inad- equate feedback and informal review request processes.” TMA advocates relief for physi-
cians who face penalties based on the hassle caused by CMS. In a Dec. 8 letter (tma.tips/GarciaPQRSletter), then-TMA President Tom Garcia, MD, along with AMA, asked Congress “to tell CMS to back off on penalizing physicians who in good faith partici- pated in PQRS in 2014.” Dr. Garcia emphasized that CMS’ “ ‘issues’ meant that thousands of U.S. physicians will now see their Medicare payments cut by 2 to 4 percent next year.” “Our experience of just the past few months has proven that CMS is much better at generating mass confusion than it is at helping physicians care for Medicare and Medicaid patients,” Dr. Garcia wrote. “The agency’s incom- petence only multiplies the burden of numerous, overly complex regulations it forces onto physicians.” As a result of the flawed PQRS re-
porting results, physicians could get hit with up to a 6-percent payment cut in 2017 and 2018. The letter warns that as Medicare converts to the Merit- Based Incentive Payment System, the “need for relevant and comprehensive performance information will only increase.” Among the blunders uncovered
with the 2016 feedback and informal review processes “was a complete lack of transparency regarding the reason that CMS assessed a penalty or de- termined an eligible professional or group practice was ineligible for an incentive. Although the lynchpin of successful PQRS participation was achieving a reporting rate of 50 per- cent or greater for the required num- ber of measures, CMS failed to include any reporting rate information in the 2014 PQRS Feedback Reports. Rather, CMS included only the measure per- formance rate, which looks not at the frequency with which measures were reported, but at the number of report- ed encounters that met the desired process of care or outcome, and is completely distinct from PQRS evalua- tion.” The AMA/MGMA letter stresses physicians spent countless hours at- tempting to interpret their PQRS per-
Quality
improvement help
TMA is collaborating with the TMF Quality Innovation Network Quality Improvement Organization to con- nect TMA members to free consulting services and techni- cal assistance to help them navigate Medi- care requirements to avoid penalties and maximize value-based payments. To take advantage of free services, join the TMF Value-Based Improve- ment and Outcomes Network,
www.tmfqin
.org/Networks/Value- Based-Improvement- and-Outcomes.
May 2016 TEXAS MEDICINE 21
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76