In 2005, the Medicare Payment Advisory Commission report called on Medicare to implement a "quality incentive payment program" for hospitals, home health agencies, and physicians. The argument-physicians need to improve quality. Michael Repka, MD, describes suitable measures for reporting to Medicare.
In 2005, the Medicare Payment Advisory Commission report called on Medicare to implement a "quality incentive payment program" for hospitals, home health agencies, and physicians. The argument-physicians need to improve quality.
At the 20th annual Current Concepts in Ophthalmology meeting in Baltimore, Michael Repka, MD, described suitable measures for reporting to Medicare in a presentation titled "PQRI and P4P: What Do You Need to Know for 2008?"
The Current Concepts in Ophthalmology meeting is sponsored by the Wilmer Eye Institute at Johns Hopkins University.
The Physician Quality Reporting Initiative (PQRI) is intended to alter public perception that quality programs do not focus solely on the financial end of quality health care.
Quality reporting outside of the Untied States has been explored. In the United Kingdom, baseline quality improved in primary care. It is unclear if quality reporting programs had any impact. The UK reporting program, which began in 2004, cost more than anticipated. Changes in reporting raised the threshold while, simultaneously, reduced bonuses.
"Physicians are doing more reporting for less or no payment," Dr. Repka said.
The American Academy of Ophthalmology's (AAO) strategy is to encourage member participation in the PQRI because there is money available for distribution to ophthalmologists. The AAO, Dr. Repka said, has a long tradition of preferred practice patterns-evidence-based guidelines for standard clinical care substantiated by quality programs. This year, the goal is to develop basic performance measures easily reported by ophthalmologists.
The Tax Relief and Health Care Act of 2006 set in place the rules for 2007. That bill stopped the negative 5% conversion factor slated for 2007. Physicians and other health-care providers who successfully meet the threshold reporting measures will earn a payment bonus, subject to a cap.
"It turns out there is a pot of money to be distributed-up to 1.5% based on how many doctors report and how many services they are eligible to get credit for," Dr. Repka said.
The 2007 PQRI eye-care measures included open-angle glaucoma (optic nerve evaluation), age-related macular degeneration (antioxidant supplement prescribed/recommended and dilated macular exam), cataract (assessment of visual functional status; documentation of pre-surgical axial length, corneal power measurement, and method of IOL power calculation; and pre-surgical dilated fundus evaluation) and diabetic retinopathy (documentation of presence/absence of macular edema and level of severity; and communication with the physician managing the ongoing diabetes care).
The Centers for Medicare and Medicaid Services (CMS) aims to implement value-based purchasing to transform Medicare from a passive payer to an active purchaser of high quality, efficient health care. Promoting better quality while reducing costs will involve explicit payment incentives and pay for reporting, pay for performance, gainsharing, and competitive bidding.
"It's a lexicon today in health care," Dr. Repka said. "It's not about process measures, but it's truly going to be about outcome measures. When you look at predictions for what the measures might look like in 2010 or 2012, it's how we talk to others, getting out of our silos, and how to improve performance."