Many of you read our articles on a regular basis, and know we have discussed the Physician Quality Reporting System, so I am sure you are thinking this article will be no different. However, the quest for quality goes far beyond one measurement with CMS. Of course, Warren Averett is always concerned with the financial aspect of any part of healthcare and quality is quickly moving to be the key factor in how medical practices get paid for their services. You may think, “We provide quality care so we don’t have anything to worry about.” I am sure you do provide quality healthcare, but how are you proving it? Insurance carriers are collecting a massive amount of data, and they are tracking costs of providing care by provider. Recently, the claim forms were updated to allow up to 12 diagnoses on a claim to better assess the risk for each patient. By documenting clinical quality measures through a registry or claims basis, and documenting meaningful use in your EHR, you have started the process of providing quality data to the insurance carriers.

Other information collected in the quality category is maintenance of certification for the physicians, which has been unpopular, but it ensures those providing services are knowledgeable in the specialty in which they practice. Reducing cost is another huge factor in the measurement of quality. The OIG is currently reviewing the over utilization of lab and imaging due to the fact that some providers rely solely on expensive testing opposed to other aspects of assessment.

The patient experience is going to be measured through patient satisfaction surveys; some groups can already count this endeavor toward their clinical quality measures. Patient centeredness is important in keeping cost down, and patient engagement is important in improving the health of the patient. Patient centeredness warrants a focus on safety, efficiency, timeliness and equity. The current Patient Centered Medical Home program guides a medical practice to accreditation. The program has recently begun to apply to specialties as the Patient Centered Specialty Program. Recently, Blue Cross Blue Shield of Alabama stated this accreditation was among criteria that could earn practices reimbursement from a fee schedule that is 30 percent higher in payments.

Reporting Incentives Expire

It is important to note that 2014 is the last year a practice can earn incentive with the Physician Quality Reporting System; its purpose was to introduce quality in 2007. It is now required, those not reporting three clinical quality measures in 2014 will receive a Medicare adjustment of 2.0 percent in 2016. Groups of ten or more will be judged on quality reporting as they move to the value based payment modifier in 2016. In 2017, all providers will be paid based on quality opposed to fee for service.

It is important for administrators and physicians to understand how quality is measured and begin the process to produce good quality data. You can review websites for the major insurance carriers to assess the quality programs they have adopted and how to participate in the programs. You can also monitor physician transparency reports to see what patients are saying about the physicians in your practice. Warren Averett is your partner in finding your way through this process.