PQRS reality check

Thursday, January 01, 2015 11:24 AM
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Health care organizations ask federal government to consolidate Medicare incentive programs

by Marilyn Rissmiller, Senior Director, Colorado Medical Society

In October and November, the American Medical Association (AMA), College of Healthcare Information Management Executives (CHIME), Healthcare Information and Management Systems Society (HIMSS) and Medical Group Management Association (MGMA) authored letters expressing concerns about overlapping Medicare incentive programs and their impending penalty phases.

In 2015, three Medicare Part B quality reporting programs – the Physician Quality Reporting System (PQRS), Meaningful Use electronic health record (EHR) incentive program, and Value-Based Payment Modifier program (VBM) – will penalize physicians for unsuccessful reporting. Add in the transition to ICD-10 by Oct. 1, 2015, and the year becomes even more complex.

The AMA, specifically, asked the Centers for Medicare and Medicaid Services (federal CMS) to synchronize and simplify the requirements for avoiding the penalties and to reverse its proposals to raise total penalties from these programs to 10 percent or more in the foreseeable future. The programs were created by different pieces of legislation and their cumulative effect could levy as much as an 11 percent penalty in 2017 and a 13 percent penalty in 2020.

The AMA, CHIME, HIMSS and MGMA cited concerns with lower-than-expected Medicare numbers with meaningful use, and continued reports detailing nationwide difficulty in meeting federal guidelines for EHR requirements. The federal CMS released data that less than 17 percent of the nation’s hospitals have demonstrated Stage 2 capabilities, less than 38 percent of eligible hospitals and critical access hospitals have met either stage of Meaningful Use in 2014, and only 2 percent of eligible professionals have demonstrated Stage 2 capabilities thus far.

Though the Colorado Medical Society has been actively preparing members for the quality-improvement programs and supports reasonable programs to improve health care quality and reduce costs, CMS recognizes the high administrative burden on physicians and their practices.

To address concerns about MU, PQRS and VBM, the AMA is recommending that the federal CMS do the following.

  • Remove its all-or-nothing approach to meaningful use, make optional the measures that have been the most challenging for the vast majority of physicians and in many cases are outside of physicians’ control, shorten the reporting period for 2015 to 90 days, and reduce burdensome certification requirements that are stifling EHR usability and innovation.
  • Release aggregate 2013 PQRS and VBM data that will allow physicians and the public to evaluate the programs in a more timely fashion, create a formal appeals process to give physicians more than 30 days to seek correction of any inaccurate information, and maintain a more robust set of claims-based measures and claims reporting options to reduce additional physician reporting costs.
  • Limit the implementation of the VBM if Congress and the administration are still determined to impose it on all physicians. If VBM is not repealed, the AMA asks the federal CMS to at least provide more time to gauge its results on large physician groups before penalties are ratcheted up and extended to small and singular-owned practices.

AMA EVP James Madera, MD, said in the letter that no other segment of the health care industry faces penalties as steep as these and no other segment faces such challenging implementation logistics. While the AMA expresses sympathy for the federal CMS as the agency “struggles to meet unrealistic deadlines with inadequate resources and a flawed IT platform,” moving forward with these programs threatens to damage the agency’s image and physician confidence in the government’s goal of achieving a more efficient health care system, he said.

MGMA supports making “significant” changes to the programs. “They present an untenable situation for physician practices who are forced to focus internal resources on government reporting, rather than patient care. MGMA calls on [the federal] CMS to support, not punish, physician practices. The agency should take immediate action to truly harmonize Medicare quality initiatives. Medicare’s focus should be on meaningful quality improvement efforts that provide timely, actionable feedback aimed at improving patient care.”

“It is time to reassess where these programs are going and how to get there,” Madera said. “The AMA offers our assistance in such an endeavor, which should begin with a realistic assessment of [the agency’s] resource constraints, the methodological challenges, and the limitations of an all-or-nothing approach that is creating an unsustainable burden on physician practices and threatens the continued access to care of some of Medicare’s frailest patients.”

Get help from Telligen on impending Medicare penalties

The Telligen Quality Innovation Network - Quality Improvement Organization (QIN-QIO) is offering in-office assistance with PQRS, MU and VBM at no cost to providers (office, ambulatory surgery centers, inpatient psychiatric facilities and hospitals settings) to help them understand and meet requirements to avoid penalties and receive payment incentives.

Telligen provides:

  • Training and education to optimize EHR technology capabilities
  • Networking and sharing opportunities with other participants focused on spreading best practices and learning from successful improvement efforts
  • Access to no-cost tools and resources to help you improve processes, patient education and care coordination
  • Assistance with identifying gaps in quality care, including those related to health care disparities and coordination of care
  • Educational opportunities, including conferences and webinars, at no cost
  • Data collection and analysis for quality improvement initiatives

In collaboration with the Centers for Medicare and Medicaid Services, Telligen is supporting the HHS National Quality Strategy to accomplish better care, better health for people and communities, and affordable care through improvements. Working together within a three-state network, teams in Iowa, Illinois and Colorado will work side-by-side with providers in all settings of care on quality improvement initiatives, while pooling resources and common elements to best serve the needs of beneficiaries, families, caregivers and health care providers across the region.

For more information on this assistance, contact Devin Detwiler by email at devin.detwiler@hcqis.org or by phone at (303) 875-9131.

Posted in: Colorado Medicine | Practice Management | Health System Reform


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