Regardless of how they report, Polasky said providers must move quickly to ensure they avoid the penalties associated with noncompliance. She compared the process to e-prescribing, which caught some physicians off guard, despite years of advance notice, when they saw reductions in their Medicare payments for noncompliance.
Explore this issue:December 2012
To that end, Kylanne Green, executive vice president of health services for Inova Health System of Falls Church, Va., said most hospitals aggregate quality data by physician. But Polasky said it would be wise for individual physicians to find out if their practice is reporting PQRS measures. Otolaryngologists shouldn’t assume the EHR system they work with will automatically do the work for them, because the vendor may not have included or enabled a PQRI module. “You need to be your own advocate and make sure that the systems you have in place will do what you think they’re going to do,” she said. “Ask the question up front.”
Polasky added that, aside from determining how to report, physicians and practices need to choose what they will report. The CECity registry will work for otolaryngologists who choose to report on a measure group or three individual measures from a list of CMS-approved measures. Physicians who use the “individual measure” option must report on 80 percent of their eligible Medicare Part B fee-for-service patients.
“Measures have to meet certain specifications and standards and be ‘endorsed’ by [the National Quality Forum] and CMS before a doctor can get credit for complying with it,” Dr. Nielsen said. “One can’t just make up a measure and report on it. If doctors in hospitals are not providing the kind of care relevant to the endorsed measures for their specialty, then there is nothing on which they can report.”
Physicians and practices also have an option to report on grouped measures. There are different options for how many patients must be reported on, depending on sample methods, but the number typically ranges from 15 to 30 patients.
For the Greater Good
Physicians should not look at PQRS as the latest in a series of reforms “being done to them,” said Dr. Nielsen. Also, they shouldn’t fall into the trap of believing that deadlines will be repeatedly delayed, as has been the case with Congress’ approach to long-term fixes to the sustainable growth rate formula used to calculate Medicare payments. Instead, they should look to embrace quality improvement, keeping in mind that it betters patient care, especially given the fact that the inevitable trend toward value-based payments means that otolaryngologists who perform with better quality will be paid better.