CMS Reporting Program Leads AAFP to Develop Tools for Participating FPs

Family physicians interested in participating in CMS' physician voluntary reporting program, or PVRP, now can go online to register their intent to participate in the program. For those who decide to register, AAFP has developed online resources to help them integrate the program into their practices.

The PVRP is designed to help physicians capture data about the quality of care they provide to Medicare patients. Physicians will feed this data to CMS; the agency will collect it and then provide confidential feedback to participating physicians so they can assess and improve their quality of care.

"I urge physicians to look at the program and decide if they can or can't do it," said AAFP President Larry Fields, M.D., of Ashland, Ky., in a recent interview. He noted that the program would require physicians to take on additional administrative work, so it should "not be entered into lightly."

On the other hand, added Fields, this program allows physicians "to be ahead of the game if CMS puts pay-for-performance programs into action." The PVRP is widely believed to be CMS' first step toward developing a P4P program.

In addition, said Fields, participation indicates that family physicians are willing to be transparent in their quality measures and "indicates to CMS that FPs are willing to work with them to develop quality indicators."

Quality reporting programs increasingly are being tied to physician payments in both the private and public sectors. Many FPs already are dealing with such programs on the private side, and Congress has indicated to the Academy that it will not consider fixing the sustainable growth rate, on which Medicare payment rates are based, until it has a clear indication that health care professionals are willing to participate in finding solutions to the growing cost of health care in the United States.

CMS announced the PVRP in October 2005 as a first step in moving toward "reporting and payment systems that will support and reward quality," according to a CMS fact sheet on the program. The announcement immediately drew criticism from AAFP and other primary care organizations, who identified the PVRP as an onerous program in a negative payment environment with measures that had not been reviewed or approved by national health quality organizations.

After a December meeting with AAFP leaders, CMS scaled the program back from 36 quality measures to 16, of which only seven apply to office-based family physicians. In addition, six of the seven measures are taken from the Ambulatory Care Quality Alliance starter set, which uses evidence-based clinical performance measures and outcomes reporting tools.

The seven quality measures of the PVRP that will affect primary care physicians include three for Medicare patients with diabetes, one for heart failure, one for postmyocardial infarction, one for screening for falls and one for depression.

FPs who decide to participate in the PVRP can take advantage of several tools and techniques developed by the Academy for family physicians to help them collect the data. Although the tools don't rely on electronic health record systems to gather data, practices that have an EHR system can use the tools to develop templates for data collection and reporting, according to the Academy.

The tools include a prospective data collection sheet (PDF file: 1 page / 115 KB. More about PDFs.) that can be used at the time patient care is provided. The one-page checklist incorporates the PVRP's seven primary care measures and can be attached to a patient's chart at each visit.

In addition, the Academy is providing an information sheet (PDF file: 1 page / 91 KB. More about PDFs.) designed to help coders and billing personnel select the appropriate G codes, or CPT II codes where they exist, to report compliance with quality measures. The Academy also is providing information (PDF file: 3 pages / 105 KB. More about PDFs.) on how to introduce these tools efficiently into a practice's office workflow.