The Patient Protection and Affordable Care Act of 2010 (ACA) is described as the most sweeping health care legislation passed in the U.S. since Medicare’s implementation in 1965. The health reform law is already changing the health care system, but the most profound modifications are yet to come. The law will affect otolaryngologists’ practices in many ways, both direct and indirect. Here are some areas of the law to consider.
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December 2011Physician Quality
The law extends Medicare’s voluntary Physician Quality Reporting Initiative (PQRI), renamed the Physician Quality Reporting System (PQRS), setting incentive payments at 1 percent for 2011 and 0.5 percent from 2012 through 2014. Doctors who participate in qualified maintenance-of-certification programs could receive an additional 0.5 percent.
In 2015, physicians who do not successfully participate in the PQRI/PQRS will see their Medicare payments reduced. The penalty will be 1.5 percent in 2015 and 2 percent after that.
Many physician groups argue that the PQRS still has problems and shouldn’t become punitive unless and until it is run properly. A Medical Group Management Association survey released in January 2010 found that nearly 50 percent of physicians found it difficult or very difficult to capture and submit PQRS data, compared with 31 percent who found it easy or very easy. Another concern physicians have about making PQRS punitive is its lack of quality measures for some specialties, including otolaryngology.
The law includes some PQRS improvements: Medicare must establish an informal appeals process for physicians who believe they should have gotten a bonus, and participants must receive “timely feedback” on their performance.
The ACA also aims to improve physician quality by mandating the creation of a value-based payment modifier under the Medicare Physician Fee Schedule. The modifier will provide for differential payment to physicians or groups of physicians based on quality of care compared to cost during a performance period. Medicare will begin applying the modifier to some physicians’ pay in 2015 and to all physicians in 2017. Physician groups believe that because the fundamentals of this program are still under development, the initiative should not start in 2015.
Physician Gift Disclosure
Starting in 2013, physicians who receive gifts of $10 or more from a drug manufacturer, device maker or other medical industry firm will see their names and addresses listed on a publicly searchable website. Also listed will be a description of the type of payment. This will include consulting fees, honoraria, gifts, entertainment, food, travel, education, research, charitable contributions, royalties, speaking fees and grants.