Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Insurance companies must more actively engage physicians in quality measurement programs, suggests new research.
A new paper published in the Journal of the American Medical Association is encouraging insurance companies to more actively engage you in quality measurement programs.
Physicians and hospitals already are expected to demonstrate the value of their services by measuring quality of care, reporting to payers and through increased public transparency, according to Patrick H. Conway, MD, MSc, and Christine K. Cassel, MD, MSc, authors of “Engaging physicians and leveraging professionalism: A key to success for quality measurement and improvement.”
As insurance companies and regulators began to step in and use models of pay-for-performance and value-based purchasing, the Centers for Medicare and Medicaid Services (CMS) initiated its own physician quality reporting program in 2007, which now rewards physicians for reporting approved quality measures and many process-of-care measures.
But a growing concern exists that the results of pay-for-performance programs and public reporting are not working quickly enough to create the desired improvements in the health system, the authors say. Small groups and solo practitioners have lower successful reporting rates, and Conway and Cassel suggest that it is due, at least in part, to the relatively small payments outlined in the congressional statute. They argue that the payments are not high enough to offset the additional work and costs required to collect and transmit quality reporting information.
Changes implemented by CMS to the Physician Quality Reporting System in 2011, and specifically meaningful use and physician fee schedule rules, are steps toward better long-term policies, according to the paper. Conway and Cassel say stakes will be raised even higher for doctors with the implementation by CMS of a physician value modifier, which will adjust payments to all doctors based on performance by 2017.
The authors say that doctors are recognizing the need to demonstrate quality on their own, and many have already chosen to demonstrate it via maintenance of certification (MOC) through the American Board of Medical Specialties.
Although the board certifications have existed for more than a century for specific medical specialties, all 24 specialty boards had established a need for periodic recertification by 2002, the authors say. Additionally, the percentage of physicians who have never been board-certified is declining. This shift is in response to both the ever-changing nature of medicine and the call for more public accountability, according to the paper.
Physician engagement in MOC has been better than expected, despite requirements that often exceed payer programs, perhaps because the process of recertification is familiar to doctors, the authors continue. Closer alignment for physicians who choose to use MOC assessments with CMS programs for quality reporting and value-based purchasing could lead to better information for consumers, and new partnerships between CMS and specialty organizations could lead to a fully integrated system of data collection and reporting with greater physician engagement, according to the authors.
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