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Not So Fast: New quality provisions aren’t ready for implementation, medical groups say

by Geri Aston •

A timeline of quality provisions

2010

  • PQRI is extended through 2014.
  • The Patient-Centered Outcomes Research Institute is created. It replaces the Federal Coordinating Council for Comparative Effectiveness Research.

2011

  • HHS must have an informal appeals process for physicians who have not satisfactorily submitted PQRI quality measures.
  • HHS must submit a national quality improvement strategy to Congress.
  • The new Center for Medicare & Medicaid Innovation must begin carrying out its role of testing payment and service models that reduce spending while preserving or enhancing quality.
  • HHS prohibits federal payments to states for Medicaid services related to healthcare-acquired conditions.

2012

  • HHS must publish quality-of-care and cost measures for a value-based payment modifier to be applied to the Medicare physician fee schedule.
  • HHS must develop a plan to integrate the PQRI and electronic health record quality reporting programs.
  • Medicare reduces payments that would otherwise be made to hospitals to account for excess hospital readmissions.
  • HHS must publish an initial core set of adult health quality measures for Medicaid.
  • HHS establishes a program in which accountable care organizations that meet quality standards can share in the cost savings they achieve for Medicare.
  • HHS establishes a hospital value-based purchasing demonstration program in Medicare.

2013

  • HHS undertakes a national Medicare pilot program aimed at improving quality and efficiency by bundling payment for hospital and physician care.

2015

  • Medicare payment penalties begin for physicians who don’t satisfactorily submit data on quality measures.
  • The value-based Medicare payment modifier is applied to certain physicians and physician groups.
  • Medicare payments to certain hospitals for hospital-acquired conditions are reduced by one percent.

2017

  • The value-based Medicare payment modifier is applied to all physicians and physician groups.

Sources: Patient Protection and Affordable Care Act, the Kaiser Family Foundation

Specialty-Specific Measures Needed

Another problem with making PQRI punitive is the lack of quality measures to report for some specialties. Physicians in specialties that don’t have many measures or have difficulty getting measures could get hit once the payment reduction kicks in, said Kristen Hedstrom, assistant director of legislative affairs for the American College of Surgeons.

Only a small percentage of otolaryngologists participate in PQRI because few measures apply to them, said Jean Brereton, senior director of research, quality improvement and health policy at the American Academy of Otolaryngology-Head and Neck Surgery. Creating measures and getting them endorsed is a time-consuming and resource-intensive process that is especially difficult for small specialties, she said, adding that it’s not likely that the government will produce and endorse enough measures for otolaryngologists by 2015. “We are supportive of moves to be able to report on quality,” Brereton said. “It’s just the aggressiveness of the time frame they’ve laid out that we’re concerned about.”