Physician quality reporting may do more harm than good

Physician Quality Reporting (PQRI) sounds good, doesn’t it?  After all, delivering “quality” is what it’s all about, right?  Maybe.  Maybe the government’s efforts are really designed to improve the quality of the practice of medicine in the US.  Unfortunately, PQRI has fallen short of its reported goal by a long shot.

PQRI is time consuming.  PQRI is expensive.  I think PQRI has more potential to do harm than it does to do good.  At first glance, there are several hundred PQRI codes (measurements) that can be reported.  Items to be reported to Medicare include diabetic care, depression, stroke, ocular disorders, heart disease, smoking status, alcohol consumption, lung disease, liver disease, and a vast assortment of other medical illnesses and treatments.  In researching this topic I was not surprised to find that there were only 8 preventative medicine codes out of over 250 codes in my computer’s data base.  So much for the government’s professed interest in preventative medicine.

In order to qualify for my Medicare bonus bucks and meet meaningful use criteria, each and every day I click on at least 4 PQRI codes that pertain to my patient’s illness code.  Medicare’s data banks record who is naughty and who is nice, whose diabetes is controlled and who is not, who is depressed, who drinks too much, etc.  So far, I have not received any quality feedback nor have I seen any literature that accumulating quality data is beneficial.

Actually, sending data is beneficial.  It helps pay the bills.  Medicare’s reimbursement for services rendered is poor.  There are times when seeing Medicare patients actually costs me money.  Without Medicare’s paltry bonus bucks, Medicare is a losing concern.

While reporting PQRI codes is voluntary, it’s not.  Bonus bucks and payment for meaningful use are mandatory sources of income that help keep a family physician’s doors open.  Unfortunately, PQRI will become mandatory in the future.  As the command structure of the EMR improves, the practice of medicine will change in ways no one could ever imagine.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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  • http://twitter.com/AACMaven Henry Ehrlich

    As in teaching, the emphasis on industry-inspired measurement in medicine is bound to backfire and distort results.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Starting in 2015, and based on what you submit in 2013, there will be no PQRS bonuses. You need to report next year just so you don’t get penalized in 2015.
    For a pretty clear summary (if I may say so :-) of all carrots and sticks from CMS, including some real dollar implications and tables, read here: http://onhealthtech.blogspot.com/2012/05/whats-up-doc-medicare-carrots-and.html

  • http://twitter.com/PathcareNow Pathcare Now

    Stewart
    You have made a very important insight – which is that the HITECH Act mandate quality measures have little to do with helping reduce your stress and improve your patients health.
    According to the HITECH Act and Measuring Meaningful Use the demonstration of being a “meaningful user” is:

    Electronic prescribing for physiciansBeing connected in a manner that provides… for the exchange of health information to improve the quality of health care, such as promoting care coordinationQuality measures submission when Secretary can acceptAdditional requirements: Policy question as to what additional uses required to be considered “meaningful” for a particular yearMechanism for determination: Attestation, Survey, Claim, or other could serve to document “meaningful use” for individual or group representative
    If you read this carefully, you will be hard put to understand how meaningful use makes patients healthier, improves the doctor-patient relationship, reduces physician stress, enables physicians to improve the quality of care with evidenced based medicine and encourages Americans to walk instead of taking the car.
    Since the HITECH-prescribed quality measures are vague and not focused on the patient-physician interaction, nor on clinical issues, nor on scientific evidenced based medicine, nor on patient, nor on physician education; it seems to me that the actual contribution to improving quality at the point of care is zero.

    Danny Lieberman

    See – http://pathcareblog.com/lets-improve-patient-health-by-ignoring-patients/
    for a longer essay of mine on this point.

  • http://cognovant.com/ W Joseph Ketcherside, MD

    I believe the article’s title is a bit off. It sounds like the problem is with PQRI system, and not with the concept of measuring quality. I agree most of our measurement systems could improve. Thing is, I’ve been in healthcare for 30 years and have seen very few serious proposals by the medical profession on how patients can objectively assess the quality of care they receive. If we don’t measure ourselves, others will measure us.

    If we don’t like the way others measure us, we need to develop a better system and get it out there. Until we do we should expect that the government and industry will continue to measure what matters to them and use that to guide reimbursement and even the privilege to practice.

    • LeoHolmMD

      I don’t think there is an effective way of developing supply side quality measures without confounding the whole issue. What patients care about is not what the “industry” cares about. When patients do come up with something, it looks like a consumer based website: “Dr. X sucks…he didn’t return my phone call.” Or, “Dr. Y is a super guy, he saved my life!”. This information is of course useless to industry trolls and data mining bureaucrats. PQRI has nothing to do with quality.