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.”