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What's Up with Voluntary Reporting? - Part 2


This article is the second in a two-part series on the CMS Physician Voluntary Reporting Program. Part one appeared on p. 11 of the May 2006 issue.

Changes in Medicare reporting and payment are coming, and they’re coming fast. Regardless of whether you agree with where Medicare is heading or plan to participate in the first stage of these changes, you’re better off knowing what’s in store.

The first part of this article provided an overview of the Physician Voluntary Reporting Program (PVRP) that the Centers for Medicare and Medicaid (CMS) initiated at the beginning of 2006, including how the reported quality measures apply—or don’t apply—to hospitalists.

JCAHO Data Not for Sale

The Joint Commission on Accreditation of Healthcare Organization (JCAHO) has announced that it will no longer pursue “commercialization of data.” Instead of selling performance data to third-party payers as planned, the organization will treat its database of hospital performance information as a public utility, free to any organization or individual wanting access. JCAHO has not yet determined how they will make the data available.

White House Pushes for Hospital Pricing Transparency

The Bush administration has made it clear that it’s serious about requiring hospitals to disclose their prices for specific services to consumers in “user-friendly” ways. Speaking at the Federation of American Hospitals’ annual meeting, Al Hubbard, assistant to the president for economic policy, said, “If you don’t do this, it will be imposed upon you,” pointing out that four bills already have been introduced in a push for greater transparency.

Hubbard added, “How can you look yourselves in the mirror and say, ‘I can’t provide price and quality information to consumers?’”

Benefits of Reporting

Eric Siegal, MD, chair of SHM’s Public Policy Committee, is convinced that hospitalists should participate in PVRP, although he stresses that he does not speak for SHM on the matter.

“Hospital medicine has positioned itself as a champion of quality improvement,” he points out. “We talk the talk, so now we need to walk the walk [with voluntary reporting]. As a group of physicians who live and breathe this issue, we’ll have that much more credibility for supporting this program.”

Dr. Siegal not only believes hospitalists should report through PVRP, he thinks they will excel at doing so: “Because we’re already used to being measured, I have a suspicion that our adherence to these metrics is going to look very good. This will serve to bolster the argument that hospitalists add value to the care of hospitalized patients.”

Potential Problem Areas for Hospitalists

Hospitalists who participate in PVRP may face a bumpy road. “There are small problems,” admits Dr. Siegal. One of those is the disconnect between the 16 quality measures that physicians can report on and the role that hospitalists play.

“Of the 16 metrics in the starter set, maybe seven apply to hospitalists,” he explains.

Hospitalists may face another unique problem in meeting those measures: “We may have dilemmas over responsibility and reporting,” predicts Dr. Siegal. “For instance, we’re increasingly co-managing patients with surgeons. If a hospitalist wants to comply with a metric, but the surgeon disagrees, does the hospitalist take the hit? The same is true with something like administering aspirin on arrival for acute myocardial infarction. Is that my responsibility or the emergency physician’s?”

Another issue is the Healthcare Common Procedure Coding System (HCPCS) codes—or G-codes—that comprise each of the current PVRP’s 16 quality measures.

“The G-codes are cumbersome,” says Dr. Siegal. “There are G-codes for each measure, and there is talk about changing to a different system. So you may set up to report G-codes only to have the system change. But get used to it—this is a dynamic process that is definitely going to evolve.”

PVRP Is the Future

Dr. Siegal—and many others—believe that the PVRP will evolve into a broader reporting program and will ultimately transform into a mandatory pay-for-performance system for CMS. This may happen faster than CMS usually moves.

“Eventually there will be money tied to this,” he says. “Rumors are that payment modifiers may be tied to reporting as early as the fourth quarter of this year. As things go in the federal government, the evolution to value-based purchasing is moving at a lightning-fast pace—CMS is actually getting pushback from medical groups for moving too fast.”

Dr. Siegal adds that, “CMS is very interested in engaging physician organizations for their input. [CMS Administrator Mark B.] McClellan has done an admirable job of making this an interactive process.”

As PRVP evolves, it is likely to become more applicable to hospitalists.

“This is all part of a larger evolutionary trend in medicine,” explains Dr. Siegal. “Currently, hospitals and physicians are treated separately by CMS, and paid and incentivized differently. There’s growing realization that with rising costs and increased need for quality improvement hospitals and physicians need to have their incentives aligned. Things are going to change and it will take a long time for this to shake out.”

Because PVRP is the wave of the future for CMS payment, Dr. Siegal believes that hospitalists will be better off if they join in now. Voluntary reporting requires hospitalists to develop a new reporting infrastructure, and, as he says, “It’s better to do that now, with only 16 measures, than to have to do it later when there are 36 or 42.”

Dr. Siegal is convinced that hospitalists should support PVRP now, in its first stage. He also believes that SHM will begin to get involved. “We clearly need to be at this table,” he emphasizes. “Hospitalists are going to be the dominant providers of care to hospitalized Medicare patients. That said, SHM is still a relatively small society, and we don’t have the resources to engage every aspect of this debate. This is a huge and complex issue and SHM needs to use its limited resources wisely.”

SHM’s Public Policy Committee will continue to monitor what happens with PVRP and CMS, and SHM may eventually pursue membership in the national quality forums that are developing new metrics.

CMS provides details on the PVRP, including instructions on how to sign up, on their Web site at TH

Jane Jerrard regularly writes the “Public Policy” department.

Mass. Survey Shares Recommendations

Massachusetts has released results from the first state survey in the United States to rate individual doctors and practices based on patients’ experiences. A 50-question survey was mailed to members of the state’s largest health insurers, and answered by 50,000 of them.

Based on those responses, Massachusetts Health Quality Partners (HQP) gave practices between one and four stars on each of eight areas, including communication, appointment scheduling, familiarity with their patients, administration of preventive care and advice, and care coordination. The public now can view performance results for more than 400 practices at

Healthcare Spending Rises

The latest CMS annual report says that U.S. healthcare spending rose 7.4% in 2005, surpassing the $2 trillion mark. Spending is expected to increase an additional 7.3% in 2006—and that’s down from the 9.1% growth in 2002. For the second year in a row, the increase in spending on hospital services (7.9%) outpaced that of overall healthcare spending.

National Hospital Quality Report Cards Proposed

In March, Senator Barack Obama (Ill.–D) introduced legislation for national Hospital Quality Report Card Initiative, which would involve publishing reports on individual hospital quality using data submitted to CMS and other data including staffing levels of nurses, rates of infections acquired in hospitals, volume of procedures performed, and availability of specialized care. The Report Cards would be available to the public and to purchasers and payers.

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