Physician Quality Reporting System Research Articles

Paying for Quality Not Quantity: A Wisconsin Health Maintenance Organization Proposes an Incentive Model for Reimbursement of Chiropractic Services

ObjectiveThe purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. MethodsThe previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. ResultsThe generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced “Quorum”). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. ConclusionThe CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals.

The Road Ahead

The Road Ahead

Large-Scale Automated Assessment of Radiologist Adherence to the Physician Quality Reporting System for Stroke

Physician Quality Reporting System (PQRS) measure 10 assesses the percentage of radiology reports for possible stroke that document the presence or absence of hemorrhage, mass, and acute infarction. Although it is an important report quality metric, determining adherence to this measure is often laborious, limiting its practical use. The aim of this study was to assess adherence to PQRS measure 10 using an automated approach to facilitate continuous measurement. A secondary goal was to identify explanatory variables that may affect adherence. To determine measure adherence, a computerized algorithm was built, validated, and executed on 4,045 reports from CT and MRI examinations performed between January 2008 and October 2010 in patients with suspected stroke. Radiologist adherence was measured, accounting for differences in imaging modality, the presence of abnormalities, and trainee participation in report creation. Of 4,045 reports, 58.1% met the PQRS requirement, documenting all 3 components. Although the presence of infarct increased the chance of PQRS adherence (P < .001), the existence of hemorrhage had the opposite effect (P < .001). Reports that had trainee participation were more likely to be in accordance with PQRS standards (62% vs 47%, P < .001). After controlling for pertinent variables, more than 2-fold variation in individual PQRS adherence (27%-68%) remained (P < .001). A considerable portion of eligible radiology reports do not include all components proposed by PQRS measure 10. An important contributor to performance gaps resides in individual physician variability. By automating measurement and monitoring of radiologist PQRS performance, informatics tools may enable targeted interventions to improve report quality.

Physician Payment Outlook for 2012: Déjà Vu

Physician spending is complex related to national health care spending, government regulations, health care reform, private insurers, physician practice, and patient utilization patterns. In determining payment rates for each service on the fee schedule, the Centers for Medicare and Medicaid Services (CMS) considers the amount of work required to provide a service, expenses related to maintaining a practice, and liability insurance costs. The value of 3 types of resources are adjusted on a yearly basis of the combined total multiplied by a standard dollar amount, called the fee schedules conversion factor, which was $33.98 in 2011, to arrive at the payment amount. This factor will stay almost the same ($34.03) unless a 27.4% cut in the sustainable growth rate (SGR) takes place or CMS enacts further reductions. With a 27.4% cut, the conversion factor will be $24.67 in 2012 after the first 2 months if Congress fails to act. Since the inception of Medicare programs in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. The SGR was enacted in 1997 to determine physician payment updates under Medicare Part B with intent to reduce Medicare physician payment updates to offset the growth and utilization of physician services that exceed gross domestic product (GDP) growth. This is achieved by setting an overall target amount of spending for physicians’ services and adjusting payment rates annually to reflect differences between actual spending and the spending target. Since 2002, the SGR has annually recommended reductions in Medicare reimbursements. Payments were cut in 2002 by 4.8%. Since then, Congress has intervened on 13 separate occasions to prevent additional cuts from being imposed. The Medicare physician payment rule of 2012, which is still undergoing revisions -- but considered as the final rule-- is a 1,235 page document, released in November 2011. In this manuscript, we will describe important aspects of the 2012 physician fee schedule which include potentially disvalued services under the physician fee schedule, expansion of the multiple procedure payment reduction (MPPR) policy, establishment of the valuebased payment modifier, changes to direct practice expenses (PEs), electronic prescribing, the Physician Quality Reporting System (PQRS), and lab testing signatures, along with their implications. Additionally, the impact of multiple changes on interventional pain management will be described. In conclusion, interventional pain management is facing widespread challenges in the U.S. health care system. A historic reform, which has been passed by Congress and signed into law, whose survivability is not quite known yet, is affecting medicine drastically in the United States. Interventional pain management, like other evolving specialties, will probably most likely suffer under the new affordable health care law and regulatory burden. Key words: Health policy, physician payment policy, physician fee schedule, Medicare, sustained growth rate formula, interventional pain management, regulatory reform

‘Final’ 2012 Fee Schedule Still Assumes Large Cuts

‘Final’ 2012 Fee Schedule Still Assumes Large Cuts

Physician Quality Reporting System

A brief review of the Physician Quality Reporting System (PQRS) is presented highlighting the program's legislative history, eligibility requirements and incentive payment plan. Specifically, PQRS measures applicable to neuroradiology practice are discussed. Several steps are suggested for individual physicians or group practices to start participation in the program. Resources are also provided for further information on the program requirements and PQRS measures.

MOC for Dollars

The ABR has gained conditional qualification to participate in CMS's Physician Quality Reporting System (PQRS) Maintenance of Certification (MOC) Program Incentive. The ABR is 1 of only 8 specialty boards to qualify for participation in 2011; it is expected that the ABR will also qualify in 2012. As a result of this qualification, radiologists who participate in the ABR's MOC program “more frequently” than required for board certification may earn additional 0.5% bonus payments from Medicare as early as this year (2011). To earn the MOC bonus, radiologists must also participate in the PQRS program, which pays a 1% bonus for success in 2011.

SIG 15 Perspectives Vol. 16, No. 1, July 2011

SIG 15 Perspectives Vol. 16, No. 1, July 2011

Evidence-based review of primary and secondary ischemic stroke prevention in adults: a neurosurgical perspective

In this paper, the authors' aim is to provide an evidence-based review of primary and secondary ischemic stroke prevention guidelines covering most of the common risk factors and stroke etiologies for the practicing neurosurgeon. The key to stroke prevention is in the identification and treatment of the major risk factors for stroke. These include hypertension, heart disease, diabetes mellitus, dyslipidemia, and tobacco smoking. An updated approach to secondary prevention of stroke in the setting of intracranial and extracranial large vessel atherosclerosis and cardioembolism is provided along with a brief overview of pertinent clinical trials. Novel pharmacological options for prevention of cardioembolic strokes, such as new alternatives to warfarin, are addressed with recommendations for interruption of therapy for elective surgical procedures. In addition, the authors have reviewed the anticoagulation guidelines and the risk of thromboembolic complications of such therapies in the perioperative period, which is an invaluable piece of information for neurosurgeons. Less common etiologies such as arterial dissections and patent foramen ovale are also briefly discussed. Finally, the authors have outlined the quality measures in the Medicare Physician Quality Reporting System and essential guidelines for Primary Stroke Center certification, which have implications for day-to-day neurosurgical practice.