Medicare quality bonuses elude nearly half of reporting doctors
■ Total payouts were up in the third year, but only one in five eligible professionals participated in the voluntary program.
By Charles Fiegl amednews staff — Posted May 2, 2011
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Washington -- The Medicare program paid a record $234 million in quality reporting bonuses to doctors in 2009, but participation in the Physician Quality Reporting System continued to falter as a large segment of eligible professionals either failed to meet minimum requirements or did not bother with the initiative.
More than 1 million physicians and other health professionals were considered eligible for the program in 2009, the Centers for Medicare & Medicaid Services said in an April 19 report on the PQRS program. However, only about 210,000 participated in the voluntary incentive program. Out of those, only about 120,000 earned bonuses, averaging just under $2,000 per professional.
"Although participation in our pay-for-reporting programs is optional now, it should be regarded as imperative in terms of medical professionals' shared goal of improving quality of care and patient safety," said CMS Administrator Donald M. Berwick, MD. Starting in 2015, doctors must participate in the quality reporting or face reduced Medicare pay.
But participation in PQRS during the voluntary phase has proved challenging for physicians even as the quality reporting program continues to evolve. The number of quality measures from which doctors can choose has more than doubled to 194.
Doctors also can use an electronic medical record or online registry to submit quality data, although most still submit measure codes on their claims, according to the report.
Physicians remain frustrated by what they perceive as a lack of timely feedback provided in the program. They also lament the fact that a year's worth of work reporting codes often is wasted due to something as mundane as billing errors.
Jef Sneider, MD, an internist running a solo practice in Syracuse, N.Y., has reported quality data through the initiative since 2007. He didn't get paid a bonus for reporting diabetes measures for that first year, or for 2008 or 2009. Information about final incentive payments typically arrives more than nine months after the reporting year ends, so Dr. Sneider could do nothing to correct his 2009 reporting when he found out in 2010 that billing errors had prevented him from earning a bonus.
It turned out that the clearinghouse Dr. Sneider used to bill the Medicare program had removed the PQRS codes from his claims, he said. Also, the measures he chose to report in 2007 had changed, and by 2009 he was using the wrong codes to submit the quality data.
"I realized I couldn't do it by myself," Dr. Sneider said. "It was too complicated."
He switched to the registry reporting option for sending codes to the Medicare agency for the rest of 2010. Registries allow physicians to send quality data through a third party, such as a website, instead of attaching them to claims.
Dr. Sneider paid $275 for the service and believes his bonus for the year will be about $600.
Despite coming up short three times, Dr. Sneider has discovered at least one positive result from the experience. The registry option has improved his recordkeeping and tracking of diabetic patients, he said.
In addition, based on his experience with PQRS, he has contacted his state's regional extension center for help with the separate Medicare electronic medical record incentive program. He works 60 hours a week seeing patients and says he doesn't have time to review the administrative details of the meaningful use program, which also requires reporting quality data to qualify for bonuses.
Positive trends in quality
CMS officials said they have seen gains in quality during the first three years of the program. The total bonus amount more than doubled between 2008 and 2009, in part because Congress raised the incentive amount from 1.5% to 2% of a physician's total annual Medicare charges.
Examples of clinical improvements cited in the assessment of the 2009 reporting year were:
- Professionals who reported that they told patients with diabetes about potentially damaging eye-related complications rose to 93% in 2009 from 52% in 2007.
- Professionals who reported that patients with left-ventricular systolic dysfunction received recommended beta-blocker drugs increased to 95% from 64%.
- Professionals who reported that care teams effectively stopped postsurgical antibiotics shot up to 95% from 54%.
Hundreds of doctors with Emergency Medicine Physicians in Canton, Ohio, have been successful at earning bonuses by reporting measures for pneumonia patients, said Kevin Klauer, DO, the chief medical officer for the group.
The total bonuses have been less than expected, but the group of 750 emergency medicine physicians saw their payouts rise to $704,089 in 2009, up from $112,798 in 2007 and $520,227 in 2008.
The group owns a billing company, so the bonuses help offset the added costs associated with reporting quality codes. Early participation in the reporting program helped the group grow comfortable with the requirements of the program, he said.
"There are penalties on the horizon, and we were aware of it," Dr. Klauer said. "We needed to figure out how to work with the system ... otherwise we'll get caught later underprepared. The goal isn't so much to earn bonuses, but to avoid penalties."
Starting in 2015, CMS will reduce payments for physicians who fail to participate successfully. Total Medicare pay would be reduced by 1.5% in 2015 for failing to report quality codes satisfactorily. The penalty rises to 2% in 2016 and beyond.
AMA pushes for faster feedback
The American Medical Association repeatedly has urged CMS to align its incentive programs better to help alleviate confusion among separate bonus efforts. Physicians also would benefit from receiving more timely feedback from the programs, the AMA has said. For instance, physicians did not learn if they earned a PQRS bonus from the 2009 program year until October 2010. The full CMS report didn't come out until six months after that.
The health system reform law required CMS to provide timely feedback to physicians on their performances in PQRS. However, the law does not provide a definition for "timely." As a result, the Medicare agency insists it will be fulfilling the statute's requirements when it issues feedback reports later in 2012 for the 2011 reporting year.
That's not the intent of the law, the Association stated in February comments to CMS.
"Current practices are unacceptable and fall well short of the statutory requirement and intent; we urge CMS to revise it to ensure that the feedback process improves successful participation in the [PQRS] program, as is intended by" the law, the AMA said.