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Docs, Specialists ID Proposed Payment Fee Concerns

Cheryl Clark, for HealthLeaders Media, July 15, 2014

Adds Blackwelder, "The main concern for payments that are tied to G-codes is the documentation required to figure the payment. There's an increasing administrative burden placed on physicians to get additional paperwork for the care we provide. That administrative burden takes us away from taking care of patients."

Quality & Efficiency Measures
Another provision of the proposed fee rule garnering attention and concern, says Erickson, is further implementation of the complex value-based payment modifier, through which a portion of doctors pay up to 6% into a pool to reward doctors who score high in efficiency and quality outcome measures.

For 2015, she says, CMS plans to add a measure for efficiency—how much the care the physician ordered actually cost—in relation to outcomes. "So it's not just quality data that's going to be reported," she says.

Payment for value "is the way payment is going, and we're certainly very supportive of that. More broadly, though, is this program perfect? No. But none of them are. We just have to figure out a way that's fair and reasonable." She hopes CMS continues to be open to suggestions on how to make that happen.

Consumers and payers can expect to see a greatly expanded list of quality measures reported by group practices starting in 2015 under the CMS proposed rule.

According to CMS "we now propose to expand public reporting of group-level measures by making all 2015 physician quality reporting system (PQRS) group practice reporting option (GPRO) measure sets across group reporting mechanisms —GPRO web interface, registry and EHR—available for public reporting on Physician Compare in CY 2016 for groups of two or more eligible professionals, as appropriate."

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