An AAFP meeting with CMS officials bore fruit in late December when the government acquiesced to Academy concerns about the Physician Voluntary Reporting Program.
CMS Takes AAFP Advice on Physician Voluntary Reporting Program
By News Staff
1/13/2006
The revised PVRP program implements several recommendations made when CMS officials met recently with AAFP President-elect Rick Kellerman, M.D., of Wichita, Kan.; AAFP EVP Douglas Henley, M.D.; Rosemarie Sweeney, AAFP vice president for Socioeconomic Affairs and Policy Analysis; and Bruce Bagley, M.D., AAFP medical director for quality improvement.
As originally announced in October 2005, the PVRP initially identified 36 performance measures, which would be voluntarily reported to CMS using Medicare-designated G codes. AAFP objected to the program in a Nov. 15 letter, (PDF file: 1 page / 111 KB. More about PDFs.) and followed that with a December meeting with Trent Haywood, M.D., deputy chief clinical officer with the CMS Office of Clinical Standards and Quality; William Rogers, M.D, director of the CMS Physicians Regulatory Issues Team; and Robert Bennett, spokesman for the Physician Regulatory Issues Team.
In the meeting, the AAFP representatives said the 36-measure starter set was too large and would impose an insupportable administrative burden on physicians in a negative payment environment. Use of G codes added to that burden because private insurers in performance reporting and payment programs do not use them.
Moreover, many of the original measures had not been reviewed or approved by national health quality organizations, such as the Physicians Consortium, the National Quality Forum or the Ambulatory care Quality Alliance (AQA), which all use broad physician input to develop or review evidence-based clinical performance measures and outcomes reporting tools for physicians.
"We helped them come up with a reasonable pilot program that was more workable and that used measures that AQA had looked at, approved and standardized," said Kellerman. "They listened to what we said and modified their program, I thought, very significantly, to use reasonable measures that make a difference in care."
CMS trimmed the starter set to 16; of that number, only seven apply to office-based family physicians. Six of the seven are taken from the AQA starter set.
The government will continue to use G codes, at least temporarily. CMS will assign up to four G codes -- one each for reporting a measure was met, was not met, was not appropriate to the patient or was not applicable because the patient hadn't been under the physician's immediate care for the previous six months -- for each measure. Family physicians who participate in the voluntary program will add the G-codes to the CPT and ICD-9 codes used to bill Medicare.
"AMA has promised to expedite the development of CPT-II codes used for reporting performance measures, and they will work with the rest of medicine to convince Medicare to switch to their use as soon as possible," says an AAFP analysis of the revised program.
Meanwhile, the Academy is working on a set of data collection and process improvement tools that will populate Medicare claims with the required clinical data as a by-product of the patient visit. These workflow enhancements are being designed to reduce the administrative burden of participating in performance improvement programs such as the PVRP.
"The PVRP as currently designed is not perfect," the analysis says. "It does, however, offer an excellent opportunity for family physicians to implement and test clinical performance data capture and reporting processes in anticipation of a portion of the future Medicare income being tied to such processes. Despite the limitations … much of what family physicians put in place will be applicable to proliferating private sector pay-for-performance programs."
As originally announced in October 2005, the PVRP initially identified 36 performance measures, which would be voluntarily reported to CMS using Medicare-designated G codes. AAFP objected to the program in a Nov. 15 letter, (PDF file: 1 page / 111 KB. More about PDFs.) and followed that with a December meeting with Trent Haywood, M.D., deputy chief clinical officer with the CMS Office of Clinical Standards and Quality; William Rogers, M.D, director of the CMS Physicians Regulatory Issues Team; and Robert Bennett, spokesman for the Physician Regulatory Issues Team.
In the meeting, the AAFP representatives said the 36-measure starter set was too large and would impose an insupportable administrative burden on physicians in a negative payment environment. Use of G codes added to that burden because private insurers in performance reporting and payment programs do not use them.
Moreover, many of the original measures had not been reviewed or approved by national health quality organizations, such as the Physicians Consortium, the National Quality Forum or the Ambulatory care Quality Alliance (AQA), which all use broad physician input to develop or review evidence-based clinical performance measures and outcomes reporting tools for physicians.
"We helped them come up with a reasonable pilot program that was more workable and that used measures that AQA had looked at, approved and standardized," said Kellerman. "They listened to what we said and modified their program, I thought, very significantly, to use reasonable measures that make a difference in care."
CMS trimmed the starter set to 16; of that number, only seven apply to office-based family physicians. Six of the seven are taken from the AQA starter set.
The government will continue to use G codes, at least temporarily. CMS will assign up to four G codes -- one each for reporting a measure was met, was not met, was not appropriate to the patient or was not applicable because the patient hadn't been under the physician's immediate care for the previous six months -- for each measure. Family physicians who participate in the voluntary program will add the G-codes to the CPT and ICD-9 codes used to bill Medicare.
"AMA has promised to expedite the development of CPT-II codes used for reporting performance measures, and they will work with the rest of medicine to convince Medicare to switch to their use as soon as possible," says an AAFP analysis of the revised program.
Meanwhile, the Academy is working on a set of data collection and process improvement tools that will populate Medicare claims with the required clinical data as a by-product of the patient visit. These workflow enhancements are being designed to reduce the administrative burden of participating in performance improvement programs such as the PVRP.
"The PVRP as currently designed is not perfect," the analysis says. "It does, however, offer an excellent opportunity for family physicians to implement and test clinical performance data capture and reporting processes in anticipation of a portion of the future Medicare income being tied to such processes. Despite the limitations … much of what family physicians put in place will be applicable to proliferating private sector pay-for-performance programs."
