Bah, Humbug: 4 Coals in Your Stocking in 2014

Leigh Page

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January 02, 2014

In This Article

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2. Physicians Pushed to Report Quality Measures

Dr. Sobel said one of the benefits of opting out of Medicare is not being required to report data under new Medicare compliance programs, such as the Physician Quality Reporting System (PQRS). "This has caused me some great relief," he said. "All these rules -- it's so degrading." He referred to PQRS measurements as "cookbook medicine" that does little to help physicians practice medicine.

Since 2010, PQRS has been a "pay-for-reporting" system, rewarding physicians for reporting that they are measuring quality using a variety of widely accepted methods.[4] By reporting at least 3 PQRS measures of their own choosing, physicians could earn a bonus payment of 0.5% on their Medicare billing for 2013, but bonus payments end in 2014; in 2015, a 1.5% penalty will be introduced for physicians who fail to report measure, and that figure rises to 2% in 2016.

The shift to penalties could be rocky for physicians who have not been paying attention to the PQRS program, and by all accounts there are a lot of them. One study[5] found that in 2010, the first year of bonus payments, only 21% of physicians earned bonuses for reporting to PQRS. The Centers for Medicare & Medicaid Services (CMS) also suspect that some of the physicians who earned bonuses may have been gaming the system. The agency is paying a contractor almost $10 million to investigate and recover improper bonuses paid to physicians under PQRS and other reporting programs.[6]

Dr. Pauly said Medicare and commercial insurers see use of clinical guidelines as a way to control expenditures, which they think have gotten out of hand. The 2013 MedPAC report noted that from 2000 to 2012, the volume of tests ordered by physicians grew by 91% and the volume of procedures other than major procedures that they ordered grew by 68%. In comparison, the volume of evaluation and management services grew by 37%. Because of the new guidelines, "doctors don't have as much free choice to treat patients as they did in the past," Dr. Pauly observed.

Furthermore, PQRS is expected to move from pay for reporting to pay for performance in the next few years. Some of the current PQRS measures are already performance measures, according to Joel I. Shalowitz, MD, President of the Medical Care Group, a 19-physician adult and pediatric practice in the Chicago suburbs.

Until recently, Dr. Shalowitz said his practice did not participate in the program because reporting was too labor-intensive. But when his practice added an electronic medical record, reporting became a much easier task, and now he has warmed up to PQRS. "Frankly, this is good medicine," he said, noting that it encourages physicians to monitor clinically proven activities.

Bruce Bagley, MD, of the American Academy of Family Physicians initiative said PQRS nudges physicians toward use of in-house registries that track their adherence to various PQRS initiatives and help them improve their outcomes. He added that if physicians just went through the motions and reported the data without using it to improve their practices, "it would just be a waste of time."

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