Comments on: Medicare pay for performance, what went wrong? http://www.kevinmd.com/blog/2008/11/medicare-pay-for-performance-what-went.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: glenn laffelhttp://www.kevinmd.com/blog/2008/11/medicare-pay-for-performance-what-went.html#comment-88047 glenn laffel Tue, 11 Nov 2008 12:42:00 +0000 http://clients.emmense.com/kevinmd/2008/11/medicare-pay-for-performance-what-went-wrong.html#comment-88047 D'ya think CMS can learn from it's mistakes? Let's hope so, b/c they've just put forward a bonus scheme for MDs that use e-prescribing for Medicare patients! D’ya think CMS can learn from it’s mistakes? Let’s hope so, b/c they’ve just put forward a bonus scheme for MDs that use e-prescribing for Medicare patients!

]]> By: The Happy Hospitalisthttp://www.kevinmd.com/blog/2008/11/medicare-pay-for-performance-what-went.html#comment-88032 The Happy Hospitalist Mon, 10 Nov 2008 15:21:00 +0000 http://clients.emmense.com/kevinmd/2008/11/medicare-pay-for-performance-what-went-wrong.html#comment-88032 In my group of 18 doctors, I was the only one that did it right. One out of 18. Talk about making it impossible. Of the hundreds of possible quality indicators, you only have to report on 3 of them, I believe. But then each quality indicator is only good for certain CPT codes. For example. I reported on use of aspirin in coronary artery disease. But the quality indicator was only good for certain CPT codes. Such as dishcarge codes, outpatient clinic codes, rehab facility codes, inpatient consultation codes. If I admitted a patient and saw them for 6 days in the hospital and used 6 hospital follow up codes, and then my partner comes on the next day to discharge them, I couldn't report those 7 days of encounters because none of those codes qualified. However, if the cardiologist admitted and I consulted on something like diabetes, I would qualify because inpatient consult codes qualify. If I didn't link the CPT consultation code to the ICD code for CAD, then I wouldn't get credit. If I listed the ICD code for CAD but didn't report, then I would get dinged. <br/><br/>It's very complicated and unless you are making a highly concerted effort every single time you see a patient to make sure you report when you need to and don't report when it's not necessary, to avoid excess time in uncompensated work, then you won't qualify. Now, imagine all the extra work that your billing company or office staff must invest in submitting the PQRS codes, when the per doc return on investment runs $600.<br/><br/>It's a purely laughable program. The Medicare National Bank is a laughing stock for presenting such a program. In my group of 18 doctors, I was the only one that did it right. One out of 18. Talk about making it impossible. Of the hundreds of possible quality indicators, you only have to report on 3 of them, I believe. But then each quality indicator is only good for certain CPT codes. For example. I reported on use of aspirin in coronary artery disease. But the quality indicator was only good for certain CPT codes. Such as dishcarge codes, outpatient clinic codes, rehab facility codes, inpatient consultation codes. If I admitted a patient and saw them for 6 days in the hospital and used 6 hospital follow up codes, and then my partner comes on the next day to discharge them, I couldn’t report those 7 days of encounters because none of those codes qualified. However, if the cardiologist admitted and I consulted on something like diabetes, I would qualify because inpatient consult codes qualify. If I didn’t link the CPT consultation code to the ICD code for CAD, then I wouldn’t get credit. If I listed the ICD code for CAD but didn’t report, then I would get dinged.

It’s very complicated and unless you are making a highly concerted effort every single time you see a patient to make sure you report when you need to and don’t report when it’s not necessary, to avoid excess time in uncompensated work, then you won’t qualify. Now, imagine all the extra work that your billing company or office staff must invest in submitting the PQRS codes, when the per doc return on investment runs $600.

It’s a purely laughable program. The Medicare National Bank is a laughing stock for presenting such a program.

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