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The Centers for Medicare and Medicaid Services needs to make substantial changes in methodology and distribution before physician feedback reports can be considered meaningful, actionable, and reliable for individual physicians as well as groups, according to the Government Accounting Office (GAO). The reports indicate how practices are meeting criteria that will ultimately determine their Medicare reimbursement.
The Centers for Medicare and Medicaid Services (CMS) needs to make substantial changes in methodology and distribution before physician feedback reports can be considered meaningful, actionable, and reliable for individual physicians as well as groups, according to a recent report from the Government Accounting Office (GAO).
CMS currently plans to use the quality and resource use measures in the reports to calculate Medicare payments to physicians starting on January 1, 2015.
While the requirements used by CMS in Phase II testing of the reports excluded 82% of physicians in its sample, 90% of those who did qualify to receive reports were primary care physicians (PCPs). To receive a report that indicates how they are meeting criteria that will ultimately determine reimbursement, physicians had to meet three requirements: at least 30 beneficiaries in the resource use measures, at least 11 beneficiaries in the quality measures, and 30 or more physicians in the same specialty in the same geographic area. From a starting sample of 9,189, only 1,645 physicians met all three criteria. Of those individual physicians who were eligible to receive a report, none had enough beneficiaries to receive information about their patients with prostate cancer or how they performed on three of the quality measures.
The GAO report noted that CMS’ decision to use a single provider attribution method in Phase II limited eligibility, and that “multiple provider attribution method may be the more reasonable way to attribute costs.” PCPs had commented in Phase I that they had little control over the costs or quality of care provided to beneficiaries by the specialists to whom they referred.
CMS has proposed reducing the required number of beneficiaries to 20 and the number in the peer group to 15 in Phase III. The GAO noted that CMS has not performed the rigorous statistical analysis required to understand what minimums are needed to produce reliable reports-and that as the results will be used for payment decisions, the agency “must be reasonably confident that these measures reflect real differences in medical practice.”
The physician feedback reports are designed to help Medicare become an “active purchaser of higher quality, more efficient healthcare,” according to CMS. The Patient Protection and Affordable Care Act requires that CMS use a value-based payment modifier derived from the cost and quality data to calculate payments for physicians by 2015.