Blog | Thursday, August 21, 2008

Working out the kinks of quality reporting

Medicare released its first round of bonus payments to physicians who reported quality care data. But physicians say the actual payouts are relatively small and might not be worth the record-keeping, and report problems learning how well they performed.

The Centers for Medicare and Medicaid Services (CMS) introduced the Physicians Quality Reporting Initiative in July 2007. The program awards a bonus payment of 1.5% of allowed charges for Medicare patients to physicians who submitted quality measure codes. Since then, between 10 and 15 percent of internists reported at least one quality measure code, and slightly more than half earned a bonus. ACP will report more specific outcomes to members in the near future.

Internist William E. Fox, FACP, an internist in Charlottesville, Va., writes that his practice received a bonus payment below the average amount that Medicare had reported. He said that's probably because his practice is four years old, with a smaller patient panel and fewer Medicare patients.

But established internist W. James Stackhouse, MACP, of Goldsboro, N.C., received his bonus payment and questioned if it's worth continuing participating, even using simplified alternative reporting shortcuts that were released this year. He writes, "It took a lot of paperwork and screwed up billing because we had to charge 1 cent per code so that the Medicare carrier's computer would pick up the charges, and then had to manually write off that charge afterward."

His back-of-the-envelope math estimates a physician could reasonably recoup $6,000 in bonus payments, "which represents an extra 99213 visit only about 120 times in year, or about one every other day of office hours." He added that's little motivatation for the extra record-keeping.

Also, physicians who participated in the 2007 PQRI are supposed to be able to find out how they performed on a secure Web site. However, Dr. Fox has been so far unable to access his reports, a complaint voiced by users during a public forum CMS conducted, according to ACP's Regulatory and Insurer Affairs staff. Since doctors who have a bad first experience may not continue, ACP is reporting its members' frustrations back to Medicare.

Dr. Fox asked, "I wonder what results others have had?" ACP is working with the American Medical Association to survey internists about their experiences, as detailed in a report here.