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

CMS has experimented with measuring and comparing doctors’ use of resources in the Physician Resource Use Measurement and Reporting Program, but the pilot project isn’t finished yet. In the first phase, completed last year, CMS, with Mathematica Policy Research Inc., began developing and testing measures and confidential feedback reports that compare physicians on their relative resource use. About 310 reports were sent to randomly selected physicians. The second phase, which is in development, is expected to run through 2011.

This value-based modifier provision, however, is budget neutral, which means some physicians would be rewarded at the expense of others, Bennett said. Medicare plans to begin applying the modifier to some physicians’ pay in 2015 and to all physicians in 2017. Medical groups will track the provision as it goes through the federal rule-making process, Hedstrom said. “The good news about a rule is that there is an open period for comment, and I assure you, this one will get blasted out of the water,” she added.

The law also requires the U.S. Department of Health and Human Services (HHS) to submit a national quality improvement strategy to Congress. Key issues will include how it’s structured and how quality data are gathered and measured, Brereton said.

The law’s quality provisions, combined with the nomination of national quality leader Donald M. Berwick, MD, to head CMS, send a message, Dr. Healy said: “The handwriting is on the wall for our specialty and other specialties that we must determine what works well and in the most cost-effective way.”