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Rheumatology Practice Management February 2016 Vol 4 No 1 - Medicare
Rosemary Frei, MSc

The American College of Rheumatology (ACR) continues to echo the sentiment of the American Medical Association and other physician organizations that the expansion of Physician Compare by the Centers for Medicare & Medicaid Services (CMS) may not lead to the outcomes the CMS hopes for. In December 2015, the CMS added new quality measures to the Physician Compare data that are available online for individual doctors.1 It also posted data on these measures for group practices and accountable care organizations.

However, as argued by ACR President E. William St. Clair, MD, in a September 2015 letter to the CMS acting administrator, the Value-Based Modifier (VM) data, which provide the basis for cost information reported in Physician Compare, do not portray quality and cost accurately.2 The ACR believes the inclusion of Part B medications and the exclusion of Part D drugs mean that the VM is not accurate for rheumatologists and other specialists who prescribe biologics.

“The ACR supports the concept of greater transparency in quality metrics, but we continue to have significant concerns over plans to expand reporting of the 2014 quality measures on the Physician Compare website,” Douglas White, MD, PhD, Chair of the ACR’s Committee on Rheumatologic Care, told Rheumatology Practice Management. “We have concerns about the accuracy of the data, and thus the risk that patients may be misinformed and draw inaccurate conclusions about the quality of care they receive from their doctors.”

The American Medical Association issued a press release that also indicated the group’s displeasure with the expansion of data on the Physician Compare website, albeit based on somewhat different points than those raised by the ACR.3

“Given the widespread accuracy issues with the 2014 PQRS [Physician Quality Reporting System] calculations, the newly released information is premature. The data inaccuracies and difficulties with CMS’ processes grew over the last couple of months and, while CMS has acknowledged these problems, it has failed to address the underlying issues. Most importantly, consumers visiting the Physician Compare website are likely to get a false impression that it provides accurate quality information for all physicians, when in fact, due to significant data problems, the newly added information covers only about 40,000 physicians,” AMA President Steven J. Stack, MD, is quoted as saying.

The CMS is pressing forward despite these concerns. These are among many that physician groups have voiced, perhaps predictably, since the CMS first moved to provide the public with direct access to data on the quality of care provided by healthcare professionals and hospitals.

The latest changes involved the posting of 2014 data on 14 group-level PQRS measures on the Group Practice Reporting Option website,4 as part of Physician Compare.5 Posting also began in December 2015 of 6 individual professional-level PQRS measures. Both include comparing new and old medications, screening for unhealthy body weight, and formulating a follow-up plan. Data from 2014, relating to new measures for the Inpatient Quality Reporting program and additional information on several healthcare-related infections, were also posted on Hospital Care.6

The CMS news release notes that “these websites are part of an Administration-wide effort to increase the availability and accessibility of information on quality to help consumers make informed health care decisions and encourage care improvements among health care professionals and hospitals.”1 In addition, the release notes, “In future years, CMS will add additional measures to Physician Compare, which may include data collected from [electronic health rec­ord] systems and qualified registries. The criteria for public reporting require that the measures must be statistically valid and reliable, accurate, and comparable; have a minimum sample size of 20 patients; and resonate with consumers.”




References

  1. CMS expands quality data on Physician Compare and Hospital Compare to help consumers choose health care providers [press release]. Centers for Medicare & Medicaid Services website. www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015- Press-releases-items/2015-12-10.html. Published December 10, 2015. Accessed January 18, 2016.
  2. St. Clair EW. Re: Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Proposed Rule (CMS-1631-P) [letter]. American College of Rheumatology website. www.rheumatology.org/Portals/0/Files/American%20College%20of%20Rheumatology%20CY16%20Physician%20Fee%20Schedule%20Proposed%20Rule%20Comments%20CMS-1631-P.pdf. Published September 8, 2015. Accessed January 20, 2016.
  3. Stack SJ. AMA disappointed CMS moving ahead with problematic information on website for patients [press release]. American Medical Association website. www.ama-assn.org/ama/pub/news/news/2015/2015-12-10-cms-problematic-information-patients.page. Published December 10, 2015. Accessed January 20, 2016.
  4. GPRO Web Interface. CMS.gov website. www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/GPRO_Web_Interface.html. Updated January 17, 2016. Accessed January 20, 2016.
  5. Medicare.gov Physician Compare website. www.medicare.gov/physiciancompare/search.html. Accessed January 20, 2016.
  6. Medicare.gov Hospital Compare website. www.medicare.gov/hospitalcompare/search.html. Accessed January 20, 2016.
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Last modified: March 17, 2016
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