Physician Quality Incentive Payments On the Rise

Physicians are participating in Medicare pay-for-reporting programs in growing numbers, according to the 2009 Physician Quality Reporting System and e-Prescribing Experience Report from the Centers for Medicare & Medicaid Services.

More than 119,800 physicians and other eligible professionals received incentive payments totaling more than $234 million in 2009—well above the $92.4 million and $36 million paid in 2008 and 2007, respectively, for the physician quality program. Under the e-prescribing incentive program, CMS paid $148 million to 48,354 physicians and other eligible professionals in 2009, the first payment year for that program.

Participation in the physician quality reporting system is optional, but has increased by 50% each year, the report shows. The number of quality measures increased from 55 in 2007 to 74 in 2009 and now stand at 194.

The measures capture evidence-based practices that are shown to improve patient outcomes, such as providing preventive services, taking steps to reduce health care disparities, planning care for patients with chronic conditions to keep them healthy for as long as possible and integrating health information technology solutions into care delivery. Not all of the measures apply to all physicians.

For doctors, much of the data represents clinical performance measures, for example, asthma assessment, melanoma counseling on self-examination, blood pressure management for patients with chronic kidney disease, and assessment of mental status for community-acquired bacterial pneumonia.

The e-prescribing incentive program has one quality measure: HIT-adoption/use of e-prescribing.

Physicians and electronic prescribers who satisfactorily reported data on the quality measures earned an incentive payment equal to 2% of their total estimated allowed charges for covered professional services under Medicare Part B. The average incentive was $2,000 per professional and $18,525 per medical practice for the physician program; for the e-prescribing program the average bonus payment was $3,000 per eligible professional and $14,501 per practice. Payments were received in the fall of 2010.

The three specialties accounting for the largest portion of the total incentive amount of $234 million were emergency medicine (11.9%), cardiology (11.6%) and ophthalmology (11.5%).

In 2009, a number of measures showed improvements from their 2007 rates:

• The percent of professionals who reported that they communicated with patients with diabetes about potentially damaging eye-related complications of the disease jumped to 93% in 2009 from 52% in 2007.
• The percent of professionals who reported that patients with left-ventricular systolic dysfunction (a specific form of heart failure) received recommended beta-blocker drugs increased to 95% in 2009 from 64% in 2007.
• The percent of professionals who reported that care teams effectively stopped post-surgical antibiotics (to prevent overmedication and the formation of potentially drug-resistant “superbugs”) increased to 95% in 2009 from 54% in 2007.

Although participation is optional for now, providers who are eligible to participate in the e-prescribing program but choose not to will have their Medicare payments reduced beginning in 2012; the same rules will apply to the physician quality program beginning in 2015.