Docs Worry over CMS’s P4P Initiative; Health-IT Doesn’t Seem to Help


PHILADELPHIA—If pay-for-performance and other quality-based reimbursement programs ever are going to take hold, Medicare and private payers must simplify the measurement process for doctors, a recent study of practice managers suggests.

A survey of  the Medical Group Management Association (MGMA) membership this fall found widespread dissatisfaction with a Centers for Medicare and Medicaid Services (CMS) reporting program and concern that such efforts would increase administrative responsibilities with no guarantee of quality improvement or higher payments, even for those who follow the requirements to the letter. The MGMA calls this the first study of its kind on Medicare quality programs.

Called the Physician Voluntary Reporting Program (PVRP) when it debuted in 2006 and renamed the Physician Quality Reporting Initiative (PQRI) in 2007, the CMS program asks participating physician practices to report to the Medicare agency on how well they follow standardized clinical measures for various medical conditions and procedures. Practices may earn bonuses up to 1.5 percent on top of standard Medicare reimbursements starting next year.

If the experiences of MGMA members are any indication, the parameters are not entirely clear and may require significant added extra work, potentially offsetting any higher payments. 

Among MGMA members voluntarily reporting data on Medicare patients, 35 percent said they had to create an addendum to standard “superbill” forms to capture necessary information for the program. Some 22 percent assigned additional staff to this task and 17 percent had to raise staff salaries.

“It’s obvious that this process has been somewhat burdensome to this point,” MGMA President and Chief Executive William Jessee said here Monday at the Englewood, Colo.-based organization’s annual meeting.

At least anecdotally, the presence of health-IT did not make reporting any easier, in part because CMS asks practices to report clinical information through insurance claim forms. “We use an electronic medical record system, so capturing the data has not been all that difficult. However, it takes approximately two to three hours a day,” Allen Goree, CEO of the Missouri Heart Center, Columbia, said in an MGMA press release.

Furthermore, only 13 percent of respondents that took part in the program said PQRI measures were good or excellent in terms of helping patients, according to the MGMA. Among 190 practices that returned the survey, 11 percent reported data for the PVRP last year and 44 percent are involved in this year’s PQRI.

Nearly all of the 2006 participants stayed in the program for 2007, the MGMA says, despite the finding that 81 percent of this group said that end-of-year reports from CMS were either not helpful or they never received one. Most indicated that they would continue next year, even though Congress hasn’t reauthorized the program for 2008.

Meanwhile, 63 percent said they would not voluntarily participate in a private pay-for-performance program, citing lack of transparency and little support from the payers. “There is dissatisfaction with all programs,” Jessee said.

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