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.
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 www.cms.hhs.gov/PVRP/01_Overview.asp. TH
Jane Jerrard regularly writes the “Public Policy” department.