A voluntary physician reporting system recently unveiled by CMS has drawn strong criticism from the medical community, including the AAFP.
The system, dubbed the Physician Voluntary Reporting Program, would increase physicians' administrative costs in an already negative payment environment, the AAFP has told CMS officials in conference calls. Moreover, the PVRP ignores the medical community's previous input on developing uniform reporting codes and valid quality measures.
AAFP, Medical Community Strongly Oppose CMS Reporting Program
By Leslie Champlin
11/11/2005
The proposal comes on the heels of a CMS announcement that Medicare payment to physicians would fall by 4.4 percent, starting in January. Congress is considering an appropriations bill that would override the pay reduction with a 1 percent increase. Passage of the bill, however, is uncertain.
"Even if Congress acts to reverse the cut and replace it with a 1 percent update, this results in physician payment that is not keeping up with the cost of caring for Medicare patients," said Rosemarie Sweeney, AAFP vice president for socioeconomic affairs and policy analysis. "To then impose a new administrative burden on physicians, requiring additional reporting of data on measures, is a nonstarter."
Bruce Bagley, M.D., AAFP medical director for quality improvement, agreed. "The likelihood that physicians are going to do something voluntarily for Medicare went down by several notches" with that announcement, he said. "CMS is asking doctors to do something voluntarily but telling them, 'We're going to pay you less.'"
"The Academy always supports efforts for quality," said AAFP President Larry Fields, M.D., of Ashland, Ky., "but this program is overly burdensome and probably unworkable." The program includes a number of measures, some of which are not compatible with electronic health records, said Fields. "It will be a paper-and-pencil, labor-intensive effort. Even though it's voluntary, it will be cumbersome."
The PVRP, which launches in January, has identified 23 primary care quality measures with which to gauge family physicians' patient care. Participating physicians would use temporary G codes to report compliance with quality measures. Currently, participation is voluntary and is not tied to payment.
Physicians have several issues with the program, which observers consider to be a "warm-up" for a future pay-for-performance reporting system. CMS has touted the program as a chance to practice reporting quality measures to CMS before P4P requires such reporting.
"We're in favor of improving quality of care and measuring performance," said FP Joseph Zebley, M.D., of Baltimore. But, he added, "This program is untimely and flawed." An AAFP delegate to the AMA House of Delegates, Zebley spoke during a reference committee hearing on the PVRP during the AMA's recent interim meeting in Dallas.
"There is no software to interface between the proposed G codes and our electronic health records, and the proposal would stall the current work being done to study quality parameters," Zebley told the reference committee. "Some of these performance measures are not for outpatient services. Some of the measures have not been vetted by appropriate quality groups, such as the National Quality Forum. Some of the measures are nice ideas, but are not well documented in scientific studies."
Overall, the medical community has numerous concerns about the PVRP:
"Even if Congress acts to reverse the cut and replace it with a 1 percent update, this results in physician payment that is not keeping up with the cost of caring for Medicare patients," said Rosemarie Sweeney, AAFP vice president for socioeconomic affairs and policy analysis. "To then impose a new administrative burden on physicians, requiring additional reporting of data on measures, is a nonstarter."
Bruce Bagley, M.D., AAFP medical director for quality improvement, agreed. "The likelihood that physicians are going to do something voluntarily for Medicare went down by several notches" with that announcement, he said. "CMS is asking doctors to do something voluntarily but telling them, 'We're going to pay you less.'"
"The Academy always supports efforts for quality," said AAFP President Larry Fields, M.D., of Ashland, Ky., "but this program is overly burdensome and probably unworkable." The program includes a number of measures, some of which are not compatible with electronic health records, said Fields. "It will be a paper-and-pencil, labor-intensive effort. Even though it's voluntary, it will be cumbersome."
The PVRP, which launches in January, has identified 23 primary care quality measures with which to gauge family physicians' patient care. Participating physicians would use temporary G codes to report compliance with quality measures. Currently, participation is voluntary and is not tied to payment.
Physicians have several issues with the program, which observers consider to be a "warm-up" for a future pay-for-performance reporting system. CMS has touted the program as a chance to practice reporting quality measures to CMS before P4P requires such reporting.
"We're in favor of improving quality of care and measuring performance," said FP Joseph Zebley, M.D., of Baltimore. But, he added, "This program is untimely and flawed." An AAFP delegate to the AMA House of Delegates, Zebley spoke during a reference committee hearing on the PVRP during the AMA's recent interim meeting in Dallas.
"There is no software to interface between the proposed G codes and our electronic health records, and the proposal would stall the current work being done to study quality parameters," Zebley told the reference committee. "Some of these performance measures are not for outpatient services. Some of the measures have not been vetted by appropriate quality groups, such as the National Quality Forum. Some of the measures are nice ideas, but are not well documented in scientific studies."
Overall, the medical community has numerous concerns about the PVRP:
- The program places a disproportionate burden on primary care specialties.
- True quality improvement is uncertain under the program.
- Many measures in the program are of dubious validity because they merely adjust hospital level measures to individual physician practices.
- Use of G code reporting increases administrative burden and costs because few practice management and electronic health record systems are ready to facilitate participation; physician costs would rise because participation would require the purchase of updated software, which may or may not be available within the next year.
- The system does not use CPT Category II codes.
- The program has the potential for harming physicians' reputations if they decline to participate or if CMS uses data they submit for future public reporting.
- Because the program is voluntary, the data may be distorted through self-selection and, therefore, have limited usefulness.
- The reporting system is based on quality measures that likely will increase the volume of services provided by physicians; higher volume would trigger negative payment updates in subsequent years, according to the current sustainable growth formula used by CMS to determine Medicare payments to physicians.
AAFP delegates to the AMA House of Delegates supported a resolution strongly objecting to the PVRP. AMA delegates approved the resolution Nov. 8.
