Physician Quality Reporting Initiative Research Articles

PD12-03 IMPACT OF ADHERENCE TO QUALITY MEASURES FOR LOCALIZED PROSTATE CANCER ON HEALTH-RELATED QUALITY OF LIFE OUTCOMES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2015PD12-03 IMPACT OF ADHERENCE TO QUALITY MEASURES FOR LOCALIZED PROSTATE CANCER ON HEALTH-RELATED QUALITY OF LIFE OUTCOMES William Sohn, Sharon Phillips, Brock O'neil, Matthew Resnick, Tatsuki Koyama, David Penson, Daniel Barocas, and CEASAR Investigators William SohnWilliam Sohn More articles by this author , Sharon PhillipsSharon Phillips More articles by this author , Brock O'neilBrock O'neil More articles by this author , Matthew ResnickMatthew Resnick More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , David PensonDavid Penson More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , and CEASAR InvestigatorsCEASAR Investigators More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1055AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Quality indicators endorsed by national quality consortia have yet to be validated with clinical outcomes. Our objective was to determine the impact of adherence to quality indicators for localized prostate cancer on health-related quality of life (HRQOL) outcomes. METHODS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a population-based, prospective cohort study that enrolled 3691 men with clinically localized prostate cancer during 2011 and 2012, of which 2781 underwent chart abstraction. Compliance with seven quality indicators endorsed by National Quality Forum (NQF), Physician Consortium for Performance Improvement (PCPI) and Physician Quality Reporting Initiative (PQRI), was assessed. Multivariable regression was used to determine the relationship between the compliance of each indicator with scores obtained from the Expanded Prostate Cancer Index Composite (EPIC) instrument, while controlling for treatment type, patient characteristics, and disease characteristics. RESULTS Overall rates of compliance with these quality measures ranged between 64–88%. Rates of compliance with documentation-related measures were higher than for other processes of care. Three of the seven measures were weakly associated with some of the 6- and/or 12-month EPIC domain scales for sexual function and bowel function (table), while the remaining measures had no significant effect on patient-reported HRQOL. These differences in score are unlikely to be clinically meaningful changes. Other EPIC domains (irritative and incontinence) were not significantly associated with compliance with quality indicators. CONCLUSIONS While three of seven nationally endorsed quality indicators had statistically significant associations with EPIC scores, the magnitude of these relationships were not clinically significant. Compliance with these measures does not seem to influence patient-centered outcomes within 12 months. It is possible that composite measures of quality would have more of an effect on these outcomes. It is also possible that these measures may influence other outcomes, such as indices of value or efficiency. We propose that national quality consortia should indicate the anticipated effect of adherence to quality measures, so that the value of adherence to these measures can be ascertained objectively. Quality Measure Compliance Rate EPIC1 Coefficient2 p-value Avoidance of bone scan in men with low-risk tumors 76.5% No significant associations Use of bone scan in appropriately selected patients (high risk) 73.1% No significant associations ADT for High Risk patients undergoing XRT 75.0% No significant associations Documentation cT stage, biopsy Gleason at new diagnosis 72.2% Sexual 6 month 3.94 0.02 Sexual 12 month 3 0.04 Documentation of DRE, cT stage, biopsy Gleason prior to 1° therapy 64.0% Sexual 6 month 3.14 0.03 Documentation of discussion of treatment options 85.9% No significant associations Documentation of pathologic T and N stage, Gleason score, and margin status on pathology report 87.6% Bowel 6 month 1.8 0.03 (1) EPIC Summary Scores 0 to 100 (2) Adjusting for age, race, education level, income, insurance, marital status, employment status, comorbidities, biopsy gleason, PSA, cT stage, and SEER site © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e256-e257 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Sohn More articles by this author Sharon Phillips More articles by this author Brock O'neil More articles by this author Matthew Resnick More articles by this author Tatsuki Koyama More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author CEASAR Investigators More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Duelin' Registries

Duelin' Registries

Effectiveness of Hepatitis C Virus (HCV) Antiviral Treatment in Veterans With HIV-HCV Coinfection

Introduction: Quality improvement (QI) is an emerging area of importance in health care. The Medicare Physician Quality Reporting Initiative, AASLD, and AGA recommend tracking, reporting, and training in QI measures for gastroenterologists and hepatologists (1,2). Vaccination for viral hepatitis, management of esophageal varices (EV), and screening for hepatocellular carcinoma (HCC) are areas of potential QI that have been identified in the management of cirrhosis (3). Our group previously reported baseline deficiencies in vaccination for hepatitis A & B, EV screening, and HCC screening at DDW 2008. Performance feedback is one approach to possibly increase adherence to these measures. Aim: Assess if performance feedback improved adherence to guidelines and if so, see if adherence sustained over one year. Methods: DesignRetrospective and prospective chart review at a tertiary academic medical center. ParticipantsHealth care providers in an outpatient hepatology clinic caring for 2311 cirrhotics. Data regarding appropriate HCC screening, EV screening/surveillance, and documented immunity to hepatitis A and hepatitis B was obtained utilizing chart review and a database. At the start of the study, providers were given retrospective data on previous 3 years of performance on addressing health maintenance. After having providers review past performance, prospective adherence to health maintenance measures was tracked and assessed at 60 days and 365 days in all patients seen in clinic by chart review. Results: Retrospective assessment revealed baseline deficiencies in recommended health maintenance (See Table). After giving performance feedback, medical records of all cirrhotics seen in clinic were assessed for recommended health maintenance compliance. 60 days after performance feedback, documentation of immunity to hepatitis A improved to 81%, immunity to hepatitis B to 91 %, screening for HCC 100%, and EV management to 98% (p<0.001 compared to retrospective data). Performance improvement was sustained after 1 year (p=NS comparing 60 day and 365 day data). At one year, documentation of immunity to hepatitis A was 85%, immunity to hepatitis B 85%, screening for HCC 100%, and EV management 97%. Discussion: Performance feedback to health care providers can improve adherence to health maintenance guidelines in managing cirrhotics. When providers are aware that performance is being tracked, improvement is sustained over 1 year. Systems to provide performance feedback can be an important part of QI initiatives.

Performance Feedback Impacts Quality Measures in the Management of Cirrhosis

Introduction: Quality improvement (QI) is an emerging area of importance in health care. The Medicare Physician Quality Reporting Initiative, AASLD, and AGA recommend tracking, reporting, and training in QI measures for gastroenterologists and hepatologists (1,2). Vaccination for viral hepatitis, management of esophageal varices (EV), and screening for hepatocellular carcinoma (HCC) are areas of potential QI that have been identified in the management of cirrhosis (3). Our group previously reported baseline deficiencies in vaccination for hepatitis A & B, EV screening, and HCC screening at DDW 2008. Performance feedback is one approach to possibly increase adherence to these measures. Aim: Assess if performance feedback improved adherence to guidelines and if so, see if adherence sustained over one year. Methods: DesignRetrospective and prospective chart review at a tertiary academic medical center. ParticipantsHealth care providers in an outpatient hepatology clinic caring for 2311 cirrhotics. Data regarding appropriate HCC screening, EV screening/surveillance, and documented immunity to hepatitis A and hepatitis B was obtained utilizing chart review and a database. At the start of the study, providers were given retrospective data on previous 3 years of performance on addressing health maintenance. After having providers review past performance, prospective adherence to health maintenance measures was tracked and assessed at 60 days and 365 days in all patients seen in clinic by chart review. Results: Retrospective assessment revealed baseline deficiencies in recommended health maintenance (See Table). After giving performance feedback, medical records of all cirrhotics seen in clinic were assessed for recommended health maintenance compliance. 60 days after performance feedback, documentation of immunity to hepatitis A improved to 81%, immunity to hepatitis B to 91 %, screening for HCC 100%, and EV management to 98% (p<0.001 compared to retrospective data). Performance improvement was sustained after 1 year (p=NS comparing 60 day and 365 day data). At one year, documentation of immunity to hepatitis A was 85%, immunity to hepatitis B 85%, screening for HCC 100%, and EV management 97%. Discussion: Performance feedback to health care providers can improve adherence to health maintenance guidelines in managing cirrhotics. When providers are aware that performance is being tracked, improvement is sustained over 1 year. Systems to provide performance feedback can be an important part of QI initiatives.

The Physician Quality Reporting Initiative

The physician quality reporting initiative (PQRI) is a voluntary program for reporting certain quality measures on Medicare patients in return for receiving a small bonus payment. However, the PQRI procedures are such that a large number of those who try to participate do not receive incentive payments. Also, many indicate that the small bonus for participation is not worth the effort and costs incurred. Furthermore, it has been found that many of the quality measures are not a good indicator of a favorable outcome, and do not clearly promote significant increases in the quality of patient care. However, penalties will be given from the year 2015 for not participating in PQRI. Also, it is expected that PQRI will be a precursor to Pay for Performance legislation, which will require mandatory participation by physicians. Therefore, participation in PQRI now is recommended by many experts, so that health care professionals can learn the procedures and make necessary adjustments in their practice procedures.

Physician Quality Reporting Initiative

The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). The Centers for Medicare and Medicaid Services (CMS) named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 and the Medicare Improvements for Patients and Providers Act of 2008.

PQRI: From Bonus to Penalty

The recent health care legislation mandates major changes to the Physician Quality Reporting Initiative (PQRI) program, including a bonus for Maintenance of Certification (MOC) program participation. These changes should prompt radiologists to revisit their levels of participation. In this column, I describe the anticipated changes to the PQRI program, which will transition from paying a bonus for success to requiring a penalty for failure. I also describe the incentive payment for MOC program participation and point out potential long-term implications on future payment models for radiology services.

Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care

The efficacy of rewarding physicians financially for preventive services is unproven. The objective of this study was to evaluate the effect of a physician pay-for-performance program similar to the Medicare Physician Quality Reporting Initiative program on quality of preventive care in a network of community health centers. A retrospective review of administrative data was done to evaluate a natural quasi-experiment in a network of publicly funded primary care clinics. Physicians in 6 of 11 clinics were given a financial incentive twice the size of the current Centers for Medicare and Medicaid Services' incentive for achieving group targets in preventive care that included cervical cancer screening, mammography, and pediatric immunization. They also received productivity incentives. Six years of performance indicators were compared between incentivized and nonincentivized clinics. We also surveyed the incentivized clinicians about their perception of the incentive program. Although some performance indicators improved for all measures and all clinics, there were no clinically significant differences between clinics that had incentives and those that did not. A linear trend test approached conventional significance levels for Papanicolaou smears (P = .08) but was of very modest magnitude compared with observed nonlinear variations; there was no suggestion of a linear trend for mammography or pediatric immunizations. The survey revealed that most physicians felt the incentives were not very effective in improving quality of care. We found no evidence for a clinically significant effect of financial incentives on performance of preventive care in these community health centers. Based on our findings and others, we believe there is great need for more research with strong research designs to determine the effects, both positive and negative, of financial incentives on clinical quality indicators in primary care.

Medicare Fees Get Temporary Fix

You have accessThe ASHA LeaderPolicy Analysis1 Aug 2010Medicare Fees Get Temporary Fix Ingrida Lusis Ingrida Lusis Google Scholar More articles by this author https://doi.org/10.1044/leader.PA1.15092010.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Legislation signed into law at the end of June sets reimbursement for speech-language pathologists and audiologists who provide services to Medicare beneficiaries through Nov. 30, 2010, at a rate 2.2% higher than 2009 levels. The new law is retroactive to June 1, the expiration date of previous rate-setting legislation. This law is the third in a series of legislative actions that have prevented the 2010 Medicare Physician Fee Schedule (MPFS)—which cuts Medicare Part B payments by 21.2% from the 2009 MPFS—from taking effect. In previous actions, Congress postponed implementation of the 2010 fee schedule, originally scheduled for Jan. 1, 2010, first to April 1 and then to June 1. When Congress failed to take action by June 1 to postpone implementation of the new rates again, the 2010 fee schedule took effect. SLPs and audiologists who submitted claims for services provided June 1–June 25 (the date the law was enacted) should resubmit those claims for reimbursement at the rates established in the new legislation (2009 MPFS plus 2.2%), titled the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. New 2011 Rates The Centers for Medicare and Medicaid Services (CMS) recently posted its proposed rule for the 2011 MPFS. ASHA is analyzing the 1,200-page rule and will provide comments by the Aug. 24 deadline. The rule proposes a fee reduction of 6.1%—in addition to the 21.3% reduction that has been delayed this year—based on the sustainable growth rate (SGR) formula used since 1997. However, Congress is expected to act once again to prevent these reductions from taking place. New 2011 Regulations The rule also includes several new proposals: A multiple procedure payment reduction policy (MPPR) for therapy services. Medicare has a long-standing policy regarding second and subsequent surgical and nuclear medicine procedures furnished to the same patient by the same practitioner on the same day. CMS proposes to expand MPPR to therapy services; it will fully reimburse for the therapy service or unit with the highest practice expense value, and for additional procedures on the same day, reduce practice expense (i.e., supplies, equipment, and indirect costs) but not professional work and malpractice expense components of the therapy service payment. MPPR will primarily affect professions that often bill multiple procedures or bill a timed procedure more than once per visit. Nine speech-language pathology procedure codes are applicable to MPPR. For example, if an SLP provided a speech-language visit on the same day as a dysphagia visit to the same patient, payment for the dysphagia visit would be reduced by 50% of its practice expense (yielding a 24% reduction). Therapy cap alternatives. CMS has requested comments on three proposals for developing an alternative to the current cap on outpatient therapy services. ASHA has been working with CMS-contracted research projects to develop these proposals over the past two years. Alternatives would modify the current exceptions process based on severity and complexity; develop edits regarding medical necessity; or create per-session bundled payments. Absent congressional action, the exceptions process expires Dec. 31, 2010. Physician Quality Reporting Initiative (PQRI). CMS proposes to continue the current audiology and speech-language pathology PQRI measures through 2011. The 2010 incentive payment for satisfactorily reporting on measures is 2% of all allowable Medicare charges for that reporting period. The proposed rule sets an incentive payment of 1% for 2011 and 0.5% for 2012–2014. Starting in 2015, eligible professionals who do not satisfactorily report on quality measures will be subject to a penalty. This penalty will be a reduction in payments of 1.5% in 2015, and 2% in 2016 and each subsequent year. Providers participating in PQRI need to report on 80% of patients who fit into a measure; in the proposed rule, providers would need to report on only 50% of patients who fit into a measure. Telehealth. CMS makes clear that telehealth services are covered by Medicare only when specific professions are designated by law. ASHA will work with the Center for Medicare and Medicaid Innovation (a department within CMS created under health care reform) to explore ways in which telehealth services delivered by SLPs may eventually be covered by Medicare. The Aug. 31 issue of The ASHA Leader will include more information about the 2011 rule and ASHA’s comments to CMS. Author Notes Ingrida Lusis, director of federal and political affairs, at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 15Issue 9August 2010 Get Permissions Add to your Mendeley library History Published in print: Aug 1, 2010 Metrics Current downloads: 48 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2010 American Speech-Language-Hearing AssociationLoading ...

2011 Medicare Fees Are Mostly Uncertain

2011 Medicare Fees Are Mostly Uncertain

MOC Process May Be Used as Alternative to PQRI

A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative. The details have yet to be worked out, but it would mean that physicians probably would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine (ABIM). The advantage of the maintenance of certification (MOC) process is that more than 80% of all physicians already participate in it, Dr. Cassel said. Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a burdensome and confusing process. Eric Tangalos, MD, CMD, chair of AMDA's Public Policy Committee, commented, “I am an advocate for quality improvement and PQRI is one high profile example of how to reward for physician activities. I also look to find any project that can leverage one data set for another viable purpose. Unfortunately, most physicians in the long-term care environment don't have much electronic data to drill into, and this makes it very difficult to use PQRI in this care setting. Combining PQRI activities with other quality initiatives makes sense. It is cost and time effective and will benefit patients, physicians and payers alike.” Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said. ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI but be even more comprehensive,” said Dr. Cassel. Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process. Last year, about 720 family physicians participated. Alicia Ault is an associate editor with Elsevier Global Medical News.

Medicare's Physician Quality Reporting Initiative: Incentives, Physician Work, and Perceived Impact on Patient Care

The aims of this study were to compare incremental radiologist work to incremental financial incentives under Medicare's Physician Quality Reporting Initiative (PQRI) and to evaluate physicians' perceptions of the program's impact on the quality of care. Medicare PQRI bonus information was acquired for 29 radiologists from a single practice over the program's first two cycles. Incremental bonus incentive percentages were calculated using total payments from Medicare and from all payers. Physicians were surveyed regarding incremental time required to participate and their perceptions of the program's impact on the quality of delivered care. Incentive data and survey results were analyzed and compared. Despite ongoing educational and operational initiatives, mean physician Medicare PQRI incentives amounted to only 0.36% of total practice Medicare payment, well under Medicare's expected bonus of 1.5%. As a percentage of collections from all payers, PQRI bonuses amounted to just 0.11%, well less than the estimated 1.5% mean increase in overall physician work necessary for participation. Only 10 (34%) and 6 (21%) radiologists received bonuses each cycle, respectively, and only 1 (3%) achieved bonuses for both cycles. Most physicians (76%) perceived that PQRI participation in no way improved the quality of radiologic services delivered. Even when aggressively pursued, Medicare's pay-for-performance program, PQRI, yields actual physician bonuses far less than those expected, more than an order of magnitude less than requisite incremental radiologist work, with little reported impact on quality. For such programs to engender ongoing physician participation, fundamental changes will be necessary to address discordantly low incentives and perceived lack of benefit to patient care.

Expanding Medicare Audiology Coverage

Expanding Medicare Audiology Coverage

Audiology PQRI Resources Available

You have accessThe ASHA LeaderPolicy Analysis1 Jan 2010Audiology PQRI Resources Available Anne Oyler, andAuD, CCC-A Kate RomanowJD Anne Oyler Google Scholar More articles by this author , AuD, CCC-A and Kate Romanow Google Scholar More articles by this author , JD https://doi.org/10.1044/leader.PA2.15012010.6 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Audiologists have the opportunity to improve the profession of audiology and the quality of patient care by participating in the Medicare Physician Quality Reporting Initiative (PQRI) program. PQRI is a voluntary program designed to improve the quality of care to Medicare beneficiaries. Under the program, which began Jan. 1, audiologists who bill Medicare Part B and who participate in PQRI by reporting on approved quality measures are eligible for a 2% incentive payment. The three measures available to audiologists in 2010 include: Referral for otologic evaluation for patients with congenital or traumatic deformity of the ear. Referral for otologic evaluation for patients with a history of active drainage from the ear within the previous 90 days. Referral for otologic evaluation for patients with a history of sudden or rapidly progressive hearing loss. The Audiology Quality Consortium (AQC), a coalition of 10 audiology organizations formed to collaborate on the development of these measures, has created educational resources to help audiologists begin to participate in PQRI. These materials, available at the AQC Web site, include: A detailed description of each quality measure available to audiologists and the information needed to report on them. Frequently asked questions (e.g., a description of the program, why the measures are important, when incentive payments are made). A step-by-step “how-to” guide on reporting PQRI measures. Links to additional PQRI information from the Centers for Medicare and Medicaid Services. ASHA also has posted a new podcast that describes how audiologists can participate in PQRI. Author Notes Anne Oyler, AuD, CCC-A, associate director of audiology professional practices, can be reached at [email protected]. Kate Romanow, JD, director of health care regulatory advocacy, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 15Issue 1January 2010 Get Permissions Add to your Mendeley library History Published in print: Jan 1, 2010 Metrics Current downloads: 66 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2010 American Speech-Language-Hearing AssociationLoading ...

The Medicare Physician Quality Reporting Initiative: What Do Chest Physicians Need to Know?

Health-care consumers, payers, and regulatory agencies have become increasingly concerned about the rising cost and perceived deficiencies in the quality of health care in the United States. Pay-for-performance initiatives, otherwise known as value-based purchasing, are gathering political and public support as a method to address these problems. The Centers for Medicare and Medicaid Services is moving rapidly toward a system in which reimbursement is linked to quality of care. Serving as a first step, the Medicare Physician Quality Reporting Initiative (PQRI) is a program that rewards providers for reporting their performance on certain quality measures. Participating providers receive a bonus equal to 2% of their entire Medicare reimbursement for the calendar year if they successfully report on at least three measures for 80% of relevant patients seen during that year. The performance data are submitted via specifically designated Current Procedural Terminology II codes that are added to the usual codes submitted on the billing claim. Physicians should strongly consider participating in PQRI because it is likely to form the framework for future pay for performance, in which the dollars at stake may be much higher.

Nursing Home Physicians Could Get Fee Hike

Nursing Home Physicians Could Get Fee Hike

Health Reform Advances With MH Amendments on Board

Health Reform Advances With MH Amendments on Board

Medicare Quality Reporting Available: Audiology and Speech-language Pathology Measures Added to Program

You have accessThe ASHA LeaderIn Private Practice1 Nov 2009Medicare Quality Reporting Available: Audiology and Speech-language Pathology Measures Added to Program Kate Romanow, JD Rob Mullen, andMPH Anne OylerMA, CCC-A Kate Romanow Google Scholar More articles by this author , JD, Rob Mullen Google Scholar More articles by this author , MPH and Anne Oyler Google Scholar More articles by this author , MA, CCC-A https://doi.org/10.1044/leader.IPP.14152009.1 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In In 2010, private-practice audiologists and speech-language pathologists who are enrolled as a Medicare providers will be able to participate in the Medicare Physician Quality Reporting Initiative (PQRI) program. PQRI is a voluntary program designed to improve the quality of care to Medicare beneficiaries. Private-practice health care professionals who participate in PQRI by reporting on approved quality measures are eligible for a 2% incentive payment. The final 2010 Medicare Physician Fee Schedule contains three audiology measures and eight speech-language pathology measures. Audiology Measures The three audiology PQRI measures are the result of research and advocacy efforts by ASHA and the Audiology Quality Consortium (AQC), a coalition of 10 audiology organizations. Audiologists will be able to report on three quality measures that call for referral of patients of any age to a physician after an audiological evaluation finds one of three conditions: Congenital or traumatic deformity of the ear A history of active drainage from the ear within the previous 90 days (for patients who have disease of the ear and mastoid processes) A history of sudden or rapidly progressive hearing loss. Audiology measures are reportable via claims. The AQC will develop educational materials on PQRI and how to report on these measures. Further information on the audiology measures and the AQC audiology organizations is available at Audiology PQRI. Speech-Language Pathology Measures The eight PQRI measures for speech-language pathology are outcome measures (function is measured before and after services are delivered). Eight of ASHA’s functional communication measures (FCM) were approved as PRQI measures in large part because these measures have been validated and used for more than 10 years through ASHA’s National Outcome Measurement System (NOMS). The speech-language pathology measures are among the first approved PQRI measures that report outcomes as opposed to process measures, which indicate only that a procedure was or was not implemented but not how it affected the patient’s health and functional status. In 2010, private-practice SLPs may report outcomes in eight functional domains that compare the number of Medicare Part B patients aged 16 and older with a diagnosis of cerebrovascular disease (stroke) being treated by the provider to the number who make progress on one or more FCMs: spoken language comprehension, reading, spoken language expression, writing, motor speech, swallowing, attention, and memory. The speech-language pathology measures will be reportable only through registries approved by the Centers for Medicare and Medicaid Services (CMS); ASHA has applied for the inclusion of NOMS on the list of approved registries. Further information on these measures and on how members can participate in NOMS is available at ASHA’s Web site. CMS also has information on PQRI (click on “Educational Resources” and “Measure Codes”). Author Notes Kate Romanow, JD, director of health care regulatory advocacy, can be reached at [email protected]. Rob Mullen, MPH, director of the National Center for Evidence-based Practice, can be reached at [email protected]. Anne Oyler, MA, CCC-A, associate director of audiology professional practices, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 15November 2009 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2009 Metrics Current downloads: 106 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

Cost to primary care practices of responding to payer requests for quality and performance data.

We wanted to determine how much it costs primary care practices to participate in programs that require them to gather and report data on care quality indicators. Using mixed quantitative-qualitative methods, we gathered data from 8 practices in North Carolina that were selected purposively to be diverse by size, ownership, type, location, and medical records. Formal practice visits occurred between January 2008 and May 2008. Four quality-reporting programs were studied: Medicare's Physician Quality Reporting Initiative (PQRI), Community Care of North Carolina (CCNC), Bridges to Excellence (BTE), and Improving Performance in Practice (IPIP). We estimated direct costs to the practice and on-site costs to the quality organization for implementation and maintenance phases of program participation. Major expenses included personnel time for planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems. Costs per full-time equivalent clinician ranged from less than $1,000 to $11,100 during program implementation phases and ranged from less than $100 to $4,300 annually during maintenance phases. Main sources of variation included program characteristics, amount of on-site assistance provided, experience and expertise of practice personnel, and the extent of data system problems encountered. The costs of a quality-reporting program vary greatly by program and are important to anticipate and understand when undertaking quality improvement work. Incentives that would likely improve practice participation include financial payment, quality improvement skills training, and technical assistance with electronic system troubleshooting.

Invited commentary

The authors examine market share trends and outcomes for vascular surgeons (VS), interventional radiologists (IR), and interventional cardiologists (IC) performing peripheral arterial interventions (PAI) during 1998-2005, utilizing retrospective data from the National Inpatient Sample. Their conclusions that VS (and IC) volumes have increased significantly along with the lowest mortality and morbidity using iatrogenic injuries as a marker will warm the hearts of current and future VS. However, it must be remembered that the 23,825 cases represent a very small sample of inpatients and approximately 3% of all interventions performed annually in the U.S. In addition, almost 25% of interventionist specialties could not be discerned, intra-arterial injury was used as the sole marker for morbidity, and interventionist specialties were deduced indirectly through an algorithm based on the type of procedures performed. Nevertheless, the tantalizing and encouraging conclusions should cause us to study trends in overall market share for peripheral interventions and focus on the common quality measures most departments and hospitals utilize to issue ‘report’ cards. The American Recovery and Reinvestment Act of 2009 (ARRA) calls for a vague mandate for ‘comparative effectiveness research.' What will that mean and who will get to decide on these metrics? Even though the Pay for Performance (P4P) program initiated by Medicare and followed by private insurers has not caught on as much as was expected due to the dwarfian incentives, the Physician Quality Reporting Initiative (PQRI) measures will probably be expanded. The authors also noted that IC had the highest rates of elective admissions for peripheral interventions, suggesting, as others have, that some IC ‘find’ these lesions during cardiac catheterizations. VS are heavily outnumbered by sheer numbers of IC and yet I suspect that the increased market share for VS has resulted from an aggressive approach by our specialty in teaching its members and trainees the skill sets needed to achieve superior results. Total transparency of results and quality indicators made public in a proactive manner is critical to prevent insurance or governmental efforts to impose their own ill-defined standards. The specialty that acts in a coordinated and proactive manner to demonstrate the quality of work (tied to low mortality and complication rates and hence lower costs) performed by its members will eventually be the dominant specialty. A combination of first-rate training of the complete specialist (open/closed procedures), demonstration of superior results by hard data, and occasionally tooting our own horn should stand the future generation of VS in good stead. Peripheral arterial interventions: Trends in market share and outcomes by specialty, 1998-2005Journal of Vascular SurgeryVol. 50Issue 5PreviewVascular surgeons (VS), interventional cardiologists (IC), and interventional radiologists (IR) perform peripheral arterial interventions (PAI). In this study, we reviewed market share trends and compared outcomes for each specialty using the National Inpatient Sample (NIS). Full-Text PDF Open Archive