ered and having payment that supports that design. That’s value-based care: when the care delivery and the payment go hand in hand.”
Some large private practices and organi-
zations are attempting to better link the two with models like accountable care organiza- tions (ACOs) and bundled payments; Medi- care is trying through several programs that encourage physicians to track their quality activities and adopt technology to promote improvements. Driven by the Affordable Care Act, most of these programs steer away from payments based purely on the number of patients physicians see or tests and pro- cedures they perform, and they add incen- tives and penalties based on cost and quality factors, such as better outcomes and patient adherence to recommended care.
WHAT ARE THE DIFFERENT MEDICARE PHYSICIAN QUALITY REPORTING PROGRAMS?
There are three main programs physicians report their quality data to and a fourth un- der which Medicare uses that data to issue public “report cards” on physician quality. The programs are all interconnected, TMA Director of Clinical Advocacy Angelica Ybarra notes, and Medicare now docks phy- sicians’ pay for failing to participate.
1. Under the Physician Quality Reporting System (PQRS), physicians must docu- ment and report on the care they provide through a set of clinical quality measures. There are now hundreds of measures to choose from. Over time, practices also must report on patient experience and satisfaction using Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
2. The meaningful use (MU) program re- quires physicians to demonstrate that they are using certified electronic health records (EHRs) to improve quality, safe- ty, and efficiency in their practices. Com- pliance criteria increase over time over three stages that focus on data capture and sharing (Stage 1); advanced clinical processes (Stage 2); and improved out- comes (Stage 3).
3. In 2015, Medicare implemented the
value-based payment modifier (VBM), which adjusts physician payments based on the quality data they report to PQRS and on Medicare cost data. Payments to large practices face adjustments this year based on 2013 quality and cost data, and 2015 reporting will determine payments for all physicians in 2017.
Dr. Ragain also reminds physicians of
the public element to quality reporting through Medicare’s Physician Compare website (
www.medicare.gov/physician compare). Meant to help inform patients looking
for Medicare doctors, the website displays quality ratings derived from physicians’ quality performance scores. In 2014, Medi- care posted ratings for certain large group practices and ACOs. The government plans to phase in more measures and all Medicare physicians by the end of 2015. “Uninformed consumers are going to look
at that, and it’s going to be a very inaccurate but well-publicized proxy for your quality if you are not scoring well,” Dr. Ragain said.
HOW ARE THESE PROGRAMS TIED TO QUALITY?
TMA leaders acknowledge that no quality reporting program is perfect. Dr. Kahn re- minds physicians to decide for themselves the costs versus the potential benefits. “But any time a physician can meaningfully re- flect upon his or her own practice, actively consider ways to improve it, and have con- trol over that process, that can be very use- ful,” Dr. Kahn said. His 12-physician prac- tice participates in PQRS and MU and will come under the VBM next year. One advantage to Medicare’s quality pro-
grams, over commercial programs, for ex- ample, is “at least with Medicare you get to choose, and you know ahead of time what those measures are,” he adds. “The disad- vantage is, there is some bureaucratic hassle, so it pays to plan ahead of time and under- stand exactly what the metric says.” Knowing that, Dr. Kahn can decide
whether to collect data in real time or know what codes to look for later. For the most part, the metrics he chooses, he says,
kTHE TECHNOLOGY RESOURCE CENTER (
www.texmed.org /HIT) has every- thing you need to know about meaningful use reporting and elec- tronic health record implementation.
MEDICARE QUALITY AND RESOURCE USE REPORTS (QRURs) TMA oficials urge physicians to down- load and check these performance feedback reports to preview the quality and cost scores Medicare uses to calculate your pay- ments under the new value-based payment modifier. The quality mea- sures and scores come from data you report to PQRS; Medicare supplies data for the servic- es and procedures contributing most to your patients’ costs.
kDownload your QRUR at tma.tips/ QRURreport.
kAlso, check out this FAQ page: tma.tips/QRURfaq.
™
April 2015 TEXAS MEDICINE 29
TOOLBOX Your
value-based care
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