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What’s up with Voluntary Reporting?


This article is the first in a two-part series on the CMS Physician Voluntary Reporting Program. Part two will appear in the June issue.

How aware are you of impending policies and programs that will shape how you work and get compensated? Changes are on the horizon that will affect physicians in the immediate future, including their relationship with the Centers for Medicare and Medicaid (CMS).

Your future began to change on Jan. 3, 2006, when CMS activated its Physician Voluntary Reporting Program (PVRP). The program truly is voluntary—physicians are free to decide whether they want to participate. There is no financial reward for participation, but participants receive feedback from CMS that can help them improve clinical care and data accuracy. They also get in on the ground floor of a program that is almost certain to evolve into a mandatory reporting system, and possibly a CMS pay-for-performance program.

The American College of Physicians has stated that, “While physicians are under no obligation to participate in the voluntary program, practices that choose to do so may get a sneak preview of CMS’ future pay-for-performance plans.”

Although SHM has no official position on PVRP, Eric Siegal, MD, chair of SHM’s Public Policy Committee, says that the committee has spent a “fair amount of time” examining the program. The group is interested because, as Dr. Siegal says, “Reporting of quality outcomes is the wave of the future.”

I think we should embrace the [CMS Physician Voluntary Reporting Program], even though only a few of the measures in the starter set are directly relevant to hospitalists. It will be easier to engage it now, when there are only a few metrics relevant to hospitalists.

—Eric Siegal, MD

An Overview of the Program

What are physicians volunteering to report to CMS? Participating doctors help capture data on the quality of care they provide to Medicare beneficiaries. They report on any (or any applicable) of 16 evidence-based quality measures, each one comprising two to four Healthcare Common Procedure Coding System (HCPCS) codes called G-codes. (See “16 Clinical Measures,” below, for a list of the quality measures.)

Voluntary reporting is done through the existing administrative system for claims. CMS then analyzes the data and measures the quality of services provided to Medicare patients, providing reporting physicians with confidential information on their performance.

Where Do Hospitalists Fit in?

The bright side for hospitalists is that they should have little problem with the reporting requirements of PVRP. “Hospitalists should be used to being measured, because hospitals have been reporting our adherence to quality measures through the [CMS] Hospital Compare Program,” says Dr. Siegal.

However, it’s obvious that PVRP is not designed for all physicians. “We’ve looked at the metrics, and the majority aren’t applicable to hospitalists,” points out Dr. Siegal. “But some are very relevant to us.” CMS is aware of hospitalists’ position regarding the program. Trent Heywood, deputy chief medical officer, CMS, says, “In this construct, hospitalists are in a unique situation. [They] are kind of in between—the question is whether they’re managing the patient. We’re asking things like how well was diabetes controlled and was the blood pressure controlled.”

Regardless of areas of mismatch, hospitalists can certainly participate in voluntary reporting. “I think that we should embrace the PVRP, even though only a few of the measures in the starter set are directly relevant to hospitalists,” says Dr. Siegal. “This program is the first step in a process that will dramatically change the way we are paid for our work. It will be easier to engage it now, when there are only a few metrics, than later when it’s much more pervasive.”

Meanwhile, CMS may need to juggle the reporting role of hospitalists as the program evolves. “What we don’t want to end up with is perverse incentives, where hospitals and physicians have different and potentially misaligned metrics to report,” stresses Dr. Siegal. “We have to make sure that our incentives are aligned. If possible, we should have a system that allows hospitals and hospitalists to share data and reduce the administrative burden required to report our compliance.”

Heywood agrees. “There will continue to be more dialogue about how to deal with this issue,” he says of the hospitalist role in PVRP. “How do we engage the hospitalist? Are they assumed to be on the hospital side or the physician side? We want all physicians on the same side, but that will take some time.”

Time will tell how voluntary reporting will work for hospitalists. Next month, part two of this article will examine the pros and cons of participating now.

For more information on the PVRP, including instructions on how to sign up, visit TH

Jane Jerrard regularly writes the “Public Policy” department.

16 Clinical Measures

CMS settled on the following 16 clinical measures for the test phase of their Physician Voluntary Reporting Program.

  1. Aspirin at time of arrival for acute myocardial infarction;
  2. Beta blocker at time of arrival for acute myocardial infarction;
  3. Hemoglobin A1c control in patients with Type I or Type II diabetes mellitus;
  4. Low-density lipoprotein control in patient with Type I or Type II diabetes mellitus;
  5. High blood pressure control in patient with Type I or Type II diabetes mellitus;
  6. Angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy for left ventricular systolic dysfunction;
  7. Beta-blocker therapy for a patient with prior myocardial infarction;
  8. Assessment of elderly patients for falls;
  9. Dialysis dose in end-stage renal disease patient;
  10. Hematocrit level in end-stage renal disease patient;
  11. Receipt of autogenous arteriovenous fistula in end-stage renal disease patient requiring hemodialysis;
  12. Antidepressant medication during acute phase for patient diagnosed with new episode of major depression;
  13. Antibiotic prophylaxis in surgical patient;
  14. Thromboembolism prophylaxis in surgical patient;
  15. Use of internal mammary artery in coronary artery bypass graft surgery; and
  16. Pre-operative beta blocker for patient with isolated coronary artery bypass graft.

Gainsharing Trial Gets Green Light

In February Congress approved the Deficit Reduction Act of 2005, part of which requires that the Department of Health and Human Services set up a gainsharing demonstration project that will test and evaluate methods between hospitals and physicians to improve quality and efficiency of care provided to Medicare beneficiaries. (“Gainsharing” typically refers to an arrangement in which a hospital gives physicians a cash reward that is tied to any reduction in the hospital’s costs attributable in part to the physicians’ efforts.) Hospitalists may want to collaborate with their hospitals in submitting a proposal to CMS for one of the gainsharing demonstration projects.

Pilot Program to Combine Public, Private Measures

The Ambulatory Care Quality Alliance (AQA) will launch a pilot project that will combine public and private information on physician practice. Six sites have been chosen for the project, with the goal of reporting on physician practices in a meaningful and transparent way for healthcare consumers.

The AQA pilot will not only measure quality of care, but will identify “high quality providers” who can deliver efficient care to patients.

Washington State Heads for Malpractice Reform

In March Washington state lawmakers passed a compromise medical-malpractice reform bill that will require hospitals to report serious medical errors to state regulators. The bill passed the House 82-15 and was unanimously approved by the Senate; Governor Christine Gregoire helped negotiate the bill and has publicly stated that she will sign it into law. The bill would set up a system of voluntary arbitration for malpractice cases, with maximum awards set at $1 million. It would also give the state insurance commissioner authority to approve malpractice insurance rate increases and collect information about closed malpractice claims.—JJ

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