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

The new health system reform law includes a number of quality provisions that physician organizations say are not ready for primetime and won’t be ready in the time frame established by Congress.

The two sections of most concern to medical associations involve the Physician Quality Reporting Initiative (PQRI) and the creation of a value-based payment modifier under the Medicare physician fee schedule.

The Patient Protection and Affordable Care Act not only extends PQRI through 2014, but, starting in 2015, it also institutes payment penalties for physicians who don’t report quality measures. The incentive payment for participating in the program drops from 2 percent this year to 1 percent in 2011 and 0.5 percent from 2012 to 2014. The penalty will be 1.5 percent in 2015 and 2 percent in subsequent years.

Physician groups argue that PQRI, now in its fourth reporting year, still has problems and shouldn’t become punitive until it is run properly.

“The doctors who participated in this, to my knowledge, have a difficult time getting their payments,” said Gerald Healy, MD, FACS, professor of otology and laryngology at Harvard Medical School and a former president of the American College of Surgeons. “The credibility of the program is under serious question among otolaryngologists because of prior poor experience.”

“The credibility of the program is under serious question among otolaryngologists because of prior poor experience.”

—Gerald Healy, MD, FACS

Robert Bennett, government affairs representative for the Medical Group Management Association (MGMA), said the MGMA recently discovered that the Centers for Medicare & Medicaid Services (CMS) found that analytical errors were made in determining which physicians successfully reported measures in 2008.

CMS is now making additional payments to some practices, he said. “The frustrating thing is that Congress has passed a law that makes the program punitive in 2015, and you have a situation where the Medicare agency is still trying to properly implement the second year of reporting,” Bennett said. “We have grave concerns that this program is just not ready for any sort of penalty.”

According to an MGMA survey published in January, nearly 50 percent of physicians found it difficult or very difficult to capture and submit PQRI data last year, compared with 31 percent who found it easy or very easy. When asked if the two percent payment provides enough incentive to begin or continue PQRI participation, respondents were almost evenly split, with 45 percent saying ‘yes’ and 42 percent responding ‘no.’