April 28, 2011 — Nearly 120,000 clinicians who told Medicare how they did in 2009 on certain quality yardsticks such as conducting foot exams for adults with diabetes received a total of $234 million in bonuses in 2010 — more than twice the amount for 2008 — in the program's Physician Quality Reporting System (PQRS). Good old fashion medical practice when the MD had time would include that exam each office visit. To rely and pay a bonus for the physician to record, probably by a check mark in a computer entry is ridiculous; there is no proof the exam was done.
The average payment for 2009 performance was almost $2000 per qualifying clinician, according to a report released last week by the Centers for Medicare and Medicaid Services (CMS). Some 86,000 qualifying clinicians received about $92 million, or almost $1100 apiece, for their PQRS performance in 2008.
In addition, roughly 48,000 clinicians received $148 million, or almost $3100 each, in Medicare bonuses for electronically transmitting prescriptions to the pharmacy in 2009 — the year in which the incentive program went live. The physician will have a programmed list of prescriptions in his Android or I-phone will text patients name and punch the prescription number. The doc has another piece of "time saving equipment". Saves the pharmacist from picking up a phone call or reading a written Rx. This is supposed to reduce errors. Doubtful.
Both incentive programs are part of a CMS effort to compensate physicians and other providers for the quality, not the quantity, of the care they render, as is the case under traditional fee-for-service medicine. I need proof that this will increase quality-good docs will practice good medicine, bad ones/ can the tiger change his stripes? However, the $382 million paid out under both programs combined for 2009 equals less than 1% of the $62.5 billion that Medicare spent on physician fee-schedule claims that year.
Physicians Can Choose the Measures to Report
In PQRS, which debuted in 2007 as the Physician Quality Reporting Initiative, clinicians report their performance on a handful of quality measures that they pick from a list issued by CMS. In 2009, clinicians could choose from 153 measures. The list has grown to 194 items in 2011, including:
- The percentage of patients aged 18 through 75 years with diabetes whose most recent blood pressure was in control.
- The percentage of patients aged 50 years and older who received a flu shot during the influenza season.
- The percentage of adults screened for tobacco use at least once within 24 months and counseled on quitting if they were identified as tobacco users.
- The percentage of seniors with a history of falls who had a risk assessment for falls completed within 12 months.
Despite PQRS not setting performance thresholds within a measure, participating clinicians have nonetheless improved the quality of their care, at least in some areas. For example, the percentage of clinicians who reported that they had talked to patients with diabetes about eye-related complications rose from 52% in 2007 to 93% in 2009.
Clinicians can submit PQRS data on their chosen measures to CMS through a qualified electronic health record system, Medicare claims, or a qualified online registry. With the latter 2 methods, the reporting period can be either the entire year or just the last 6 months. With an electronic health record system, the reporting period must be the entire year. Some lamebrain expert in bureaucracy must have thought this as helping patients and cutting costs.
Clinicians who successfully submitted their data for 2009 received a bonus equal to 2% of their estimated Medicare allowed charges during the reporting period. The bonus remained at 2% for 2010, and decreased to 1% for 2011. However, clinicians can earn an extra 0.5% this year for maintenance of certification, which requires year-round reporting, among other things.
The primary PQRS bonus will decrease to 0.5% in 2012, 2013, and 2014, and then disappear. The 0.5% maintenance of certification bonus continues through 2013.
Right now, participation in PQRS is voluntary. However, physicians who do not submit PQRS data beginning in 2015 will experience a 1.5% pay cut under the health care reform law called the Affordable Care Act. The penalty for nonparticipating increases to 2% in 2016 and beyond. Why should there be bonuses now and in 4years penalties? The idea is to force use of one of two software systems. The more rules and regulations there are it becomes impossible for a small two person practice to survive. The same number of Compliance individuals in a practice will work for the 2 man group and the big group. The bigger the group this individual has little impact on total net revenues.
For more information on the PQRS program, visit the CMS Web site.
E-Prescribing Must Start Before July to Avoid 2012 Penalty
Electronic prescribing used to be a quality measure in the PQRS program, but in 2009, it became the basis of its own incentive program under the Medicare Improvements for Patients and Providers Act of 2008.
Physicians who qualified in 2009 received a 2% Medicare bonus, which was also the carrot in 2010. The bonus decreases to 1% in 2011 and 2012, and then to 0.5% in 2013, the last year of the program.
As with PQRS, the e-prescribing program will shift into a penalty phase. Physicians who do not report a minimum of 10 electronic prescriptions in the first 6 months of 2011 on their Medicare claims will see their Medicare reimbursement cut by 1% in 2012. The penalty will increase to 1.5% in 2013, and to 2% in 2014 and beyond. Another report!!! What is the hidden agenda is another means of forcing physicians into a "Big Brother is Watching" situation and will also make it easier to monitor patients a privacy invasion.
If I did not keep reading the silliness that is supposed to bring about good health care to every one I would have time to write in length my opinion about the not to far impact on the c are we all will receive. Health care is being treated a s a commodity. Commodities costs money. If you reduce the amount of money-cutting costs- adjustments have to be made; either you reduce the amount or the quality. You can not get what you don't pay for.
We in Plainfield have already been a victim of the system through the loss of Muhlenberg. It was force to give care for which the State or Feds would not adequately reimburse.
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