An overwhelming number of practices surveyed say Medicare's quality reporting programs have a negative or significant negative impact on practice resources. They also say the programs negatively impact efficiency, morale, and staff time.
A new survey of physician practices shows a high rate of dissatisfaction with several Medicare programs that are meant to improve quality and cost.
The Medical Group Management Association (MGMA), representing more than 33,000 executives and administrators of medical practices, surveyed more than 1,000 medical groups in October to assess how three quality reporting programs under Medicare Part B are affecting patient care and processes.
The Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VBPM), and Meaningful Use EHR incentives (MU-EHR) are supposed to work in tandem to improve the quality and cost of patient care. But many providers who responded to MGMA's survey say the programs are not helping their organizations achieve those goals.
'Arcane' and 'Duplicative' Rules
"Medicare has lost its focus with its physician quality reporting programs," said Anders Gilberg, MGMA senior vice president of government affairs, in a statement earlier this week. "Each program has its own set of arcane and duplicative rules which force physician practices to divert resources away from patient care."
An overwhelming number of practices (76%) responded that Medicare's quality reporting programs had a negative or significant negative impact on practice resources. Providers also report that the programs negatively impact efficiency, morale, and staff time.
At issue is the administrative burden that is detracting from patient care without gaining any real value, says Louis Goodman, Ph.D., president of the Physicians Foundation, a nonprofit group focused on helping physicians understand their changing roles because of healthcare reform. Goodman is also EVP and CEO of the Texas Medical Association.
"One of the major complaints that physicians have is that they find themselves looking at a screen to make sure they meet all the requirements in the record," says Goodman.
"The doctors I talk to tell me that a small portion of the medical record is very helpful because so much of it is devoted to meeting HIPAA and other regulatory requirements that it really doesn't have an impact on their ability to see the patient or quality."
CMS set up PQRS as a quality check, by having physicians and physician practices report on different measure sets. This year, CMS adopted 287 measures in 25 measures groups to address some gaps.
But physician organizations such as the American Medical Association, the Physicians Foundation, and others have long complained about the PQRS requirements, particularly because CMS will be looking at data collected in 2013 to assess penalties or incentives in 2015.
Providers have had some access to their progress on quality measures that CMS is using, but essentially, any progress that organizations made in 2014 over 2013 will not count.
While PQRS has been a pay-for-reporting program, VBPM is a pay-for-value program with penalties or incentives beginning next year. VBPM initially applies to provider groups with 100 or more eligible professionals. It will eventually cover more and smaller provider groups by 2017.
In 2013, provider groups that were going to start being judged had to tell CMS which one of the three PQRS reporting methods it would use to avoid an automatic 1% penalty to payments in 2015.
The way CMS is determining the value modifier—upward, downward, or neutral—is by comparing performance measures of provider groups to the average of the previous year. CMS calls this "quality tiering." It isn't mandatory to participate in quality tiering until 2016.
Physicians: Give Us More Flexibility
Provider groups who opted out for 2015, will receive a neutral modifier, which won't have an impact on their payments from Medicare. To assess whether a provider group gets a ding or a bump—or nothing—Medicare will use the quality data that was collected in the PQRS from 2013, as well as cost data from traditional Medicare fee for service claims.
There is one caveat: The modifier does not apply to eligible provider groups that are taking part in CMS's Medicare Shared Savings Program or its Pioneer Accountable Care Organization program, or that are part of the Comprehensive Primary Care initiative.
CMS is under some pressure to respond to the complaints about PQRS, VBPM, and MU-EHR. In addition to MGMA's survey results, last week, the AMA sent a letter to CMS Administrator Marilyn Tavenner asking to align the programs.
Among the AMA's recommendations: giving more flexibility to organizations attempting to meet meaningful use requirements. In its letter to Tavenner, the AMA ask for CMS for a 50% threshold for incurring a penalty, and a 75% threshold for earning an incentive in MU stages 1 and 2, as well as expanding hardship exemptions for some physicians, and requiring that doctor meet only 10 measures under MU stage 3.
All three programs begin penalizing providers in 2015, and the AMA argues that the combined penalties could amount to potentially an 11% reduction in Medicare payments by 2017.
"If the physicians meet the protocol and standards for one quality program, they should be deemed successful for all," said Robert Wah, MD, AMA President.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.