WASHINGTON – The Centers for Medicare & Medicaid Services released information this week on how doctors will be measured for quality performance under the voluntary 2007 Physician Quality Reporting Initiative (PQRI).
The 74 measures 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.
In a statement Tuesday, CMS said it may expand specifications later to include additional eligible professionals.
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 will receive a bonus payment of 1.5 percent of their total allowed charges under Medicare.
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.
As early as July 2005, Herb Kuhn, director for the CMS Center for Medicare Management testified before the Senate Finance Committee of the Bush administration’s plans “to explore and advance” P4P as a method of lowering Medicare costs.
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.”
CMS Acting Administrator Leslie V. Norwalk said Tuesday 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.”
Chris Weiss, president and CEO of Dynamic Clinical Systems, Inc., said he is encouraged to see signs of CMS’s progress. He remains skeptical, however, as to whether clinicians at even the 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.”
A survey released last February conducted by HIMSS Analytics and sponsored by QuadraMed Corporation revealed that only 30 percent of physicians are ready for P4P reporting. The report, based on 300 chief operating and financial officers, nurse and physician executives, and senior information technology executives said a majority of respondents indicated they understood the importance of gathering performance indicators. Of those who don’t already gather P4P information, only 20 percent had a vision for doing so, the study said.
According to CMS, the American Medical Association Physician Consortium for Performance Improvement, the National Committee for Quality Assurance, the National Quality Forum, the AQA Alliance, and other physician and non-physician professional organizations assisted in the development of the measures.
