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The Building Blocks for Population Health Management: Real-Time Clinical Surveillance and Clinical Performance Benchmarking
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By John Haughton, MD, MS
Physicians following quality best practices are doing themselves a disservice if they are not participating in the 2011Physician Quality Reporting System (PQRS), the voluntary pay-for-performance federal program -- formerly known as the Physicians Quality Reporting Initiative (PQRI).
By John Haughton, MD, MS
Physicians following quality best practices are doing themselves a disservice if they are not participating in the 2011 Physician Quality Reporting System (PQRS), the voluntary pay-for-performance federal program -- formerly known as the Physicians Quality Reporting Initiative (PQRI). Although based on care provided during the year ending December 31, 2011, physicians who choose to submit their data through approved registries still have time to gather the data needed to qualify for the incentives being offered by the Centers of Medicare and Medicaid Services (CMS). For example, Covisint’s DocSite registry will accept data through March 2, 2012 (and possibly later); other registries may have earlier deadlines.
PQRS is worth pursuing for several reasons. Most importantly, its core quality measures that encourage best practices and lead to higher quality care and reporting on the “practice experience” are definitely the wave of the future. As a bonus, physicians can qualify for an incentive equal to 1.0 percent of their total Medicare Part B Physician Fee Schedule . And, it’s easy to do. Payment happens automatically once submissions based on care provided to 30 Medicare patients are approved. In 2010, the PQRS incentive averaged almost $2,000 per eligible professional and $18,525 per practice. Also, program improvements mean that needed information can be compiled without workflow disruption or the need to spend extra time on related administrative tasks.
CMS has made the program flexible and simple. Because incentives are based on an individual physician’s reporting on clinical data collected during patient visits, program participation is not based on an “all-or-nothing” approach. Any or all physicians within a group can choose to participate. So, if some aren’t seeing many Medicare Part B Fee-for-Service patients, their patient mix won’t stop their colleagues from earning incentives. Additionally, physicians within a group aren’t required to select the same quality measures group (QMG). This ability to match the most relevant QMG to a particular specialty within a multi-specialty group makes the program more relevant and appealing to different specialists.
However, sometimes, consistency simplifies a process. For example, since they first started participating in the program in 2009, both the primary care and specialty physicians at Soundview Medical Associates, a multi-specialty group practice based in Norwalk, Conn., have unanimously chosen the preventive care measures group to ensure that the basic health needs of every patient would be addressed regardless of the reason for their visit.
It doesn’t make sense for doctors to pass up the opportunity to get paid the 1.0 percent incentive available for care delivered during 2011, especially since the incentive drops to 0.5 percent from 2012 through 2014, and then, the carrot becomes a stick. In 2015 and beyond, there is a penalty for not reporting the practice metrics, so why not take advantage of the 2011 incentive by submitting data through a registry (many even offer discount coupons) as an easy way to “test the waters” of standardizing practice level quality reporting.
John Haughton is chief medical information officer of Covisint, a Compuware company that enables information ecosystems that quickly revolutionize organizations by providing secure communication and collaboration between people and systems. The Covisint DocSite registry (www.docsite.com) is open for PQRS reporting through March 2, 2012.