Medicare Urges Physicians to Register Intent for Physician Voluntary Reporting Program
By Michael Tooke, MD, Chief Medical Office
Delmarva Foundation
In recent months, organizations including the Institute of Medicine and the American Medical Association have drawn attention to the importance of developing performance measures for healthcare providers. In addition to these groups, major private health insurers have also turned an eye towards performance measures or pay-for- performance, unveiling new reimbursement programs for doctors who meet the insurers' standards of quality care and efficiency.
The Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services, announced in October 2005 the launch of its Physician Voluntary Reporting Program (PVRP). The PVRP is a first step for reporting information on physician quality of care. More recently, at the end of December 2005, CMS announced a simplified core set of 16 performance measures for the program after receiving valuable feedback from national physician organizations. Physicians were able to begin reporting quality data on the evidence-based measures in January 2006.
CMS is currently encouraging physicians to register their intent to participate in the PVRP through a secured link at http://www.qualitynet.org/pvrpintent. By registering intent to participate, physicians will be able to receive confidential feedback on the reporting rate and performance rate for each measure reported. In June, CMS will contact those physicians who register to walk them through final steps in the confidential registration process. Physicians who register intent to participate are not in any way obligated to participate in the PVRP. On the flip side, physicians may submit data immediately on the PVRP measures without registering intent to participate.
PVRP builds on CMS’ successful implementation of reporting mechanisms for nursing homes, home health agencies and hospitals, with a goal of substantially improving the health and wellbeing of Medicare beneficiaries and others nationwide. Given the recognized need by numerous national provider, research and consumer groups—as well as policymakers—for evidence-based quality measures to help improve the quality of health care services, this voluntary program can help Medicare and physicians become better positioned to transition to a system that promotes higher quality and rewards better health care delivery.
Organizations including the National Quality Forum, the Ambulatory Care Quality Alliance, the AMA Physician Consortium for Quality Improvement, the National Committee for Quality Assurance, and RAND worked to help provide the basis for the selection of the PVRP measures.
The PVRP is designed to provide physicians with useful feedback on improving performance on reported measures, as well as to build an increasingly accurate reporting system using physician feedback from this first phase. The PVRP system is intended to be a transitional program that will allow reporting by physicians who do not yet have an electronic health record and are not anticipating adopting one in the immediate future. One use of the program may be to create a reimbursement plan for physicians that takes quality of care into consideration, frequently referred to as “pay-for-performance.” Once the PVRP system is fully developed, it will eventually be used to compensate physicians for the quality—rather than the quantity—of care they provide.
In addition, the American Board of Internal Medicine (ABIM) and American College of Physicians announced March 16 that ABIM will allow internists and sub-specialists in internal medicine who are enrolled in ABIM's Maintenance of Certification program to use performance data provided through the PVRP to receive credit toward meeting ABIM's requirement for "self-assessment of practice performance."
CMS Administrator Mark B. McClellan, MD PhD, has described the creation of the ground-breaking PVRP as a dynamic process. “We listened to our physician partners and together we are improving quality of health care for all Americans—not just Medicare beneficiaries. PVRP cannot succeed without the commitment and support of the physician organizations and I am grateful for their positive impact on our collaborative efforts.”
Eventually, electronic health records will greatly facilitate clinical data reporting and performance improvement, but adoption is not currently widespread. Physicians participating with Medicare Quality Improvement Organizations in the Doctor’s Office Quality-Information Technology (DOQ-IT) project, and using electronic health records, can report information through electronic submission into the QIO data warehouse. CMS has also created an interim model for the PVRP that will utilize a pre-existing reporting system to minimize the burden of reporting, for physicians and staff. Physicians may begin providing voluntary information through a defined set of Healthcare Common Procedure Coding System (HCPCS) codes, called G-codes (and when they are available, CPT II codes), which are reported on physician claim forms.
Delmarva Foundation is helping District of Columbia physicians move toward a more dynamic and evolving public reporting and pay-for-performance quality improvement environment. Medicare recognizes that many physicians already acknowledge the importance of such measures for the management of patient care, providing CMS with a strong starting point for the voluntary program.
For more on PVRP, including a complete listing of the PVRP quality measures, please visit http://www.cms.hhs.gov/PVRP