We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast.
Two recent reports demonstrate how ineffective this program is and how much physicians hate it. Yet, a majority of them are participating in it, purely because they don’t want to be left behind when the train leaves the station. A report from the Medical Group Management Association (MGMA), headlined “Medicare physician quality reporting programs not improving patient quality, needlessly complex,” notes “more than 83 percent of physician practices stated they did not believe current Medicare physician quality reporting programs enhanced their physicians’ ability to provide high-quality patient care” with “more than 70 percent rated Medicare’s quality reporting requirements as ‘very’ or ‘extremely’ complex.” Most concerning from the report is that “a significant majority of respondents indicated these programs negatively affected practice efficiency, support staff time, and clinician morale.”
“Medicare has lost focus with its physician quality reporting programs. Instead of providing timely, meaningful, and actionable information to help physicians treat patients, this has become a massive bureaucratic reporting exercise. Each program has its own set of arcane and duplicative rules which force physician practices to divert resources away from patient care,” said Anders Gilberg, MGMA senior vice president of government affairs, according to this article.
A connected program, maintenance of certification (MOC), sold by the private, non-profit, American Board of Medical Specialties (ABMS) and its affiliates, finds itself as the only certification-type program to be included as an approved PQRS program within the Affordable Care Act. Surely, this MOC program of physician testing and certification can be trusted to assure quality of care? No luck here either. In fact, a recent article in JAMA found that “MOC is perceived by physicians as an inefficient and logistically difficult activity for learning or assessment, often irrelevant to practice, and of little benefit to physicians, patients, or society.”
In the face of evidence that PQRS and affiliated MOC programs are not reliable methods for achieving the stated goals of improved patient care, and may in fact be worsening patient care, it would make sense to put the brakes on this program. Instead, CMS is stepping on the gas and moving to punish doctors who do not comply. “Beginning in 2015, the program also applies a payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services,” says the CMS web PQRS page. As of next year, this program moves from incentives to penalties. While Medicare payment rates have been flat since 2001, and a 2 percent sequestration reduction has been in place since 2012, physicians now face another payment reduction starting 2015. When added up, unsuccessful data reporting in 2015 will subject physicians to Medicare payment penalties as high as 11 percent, levied in future years.
Medicine is a highly personal and individual profession, with incredible variation across specialities, regions and populations in our diverse country. All centrally planned and dictated methods, do not and cannot, provide evidence of quality of care. It is obvious to any observer that these attempts are simply methods to collect data, gain control over physicians and provide rationale for payment reductions. Any successful business person could tell the government that the best way to access quality of any service would be ask the customers, or patients in our case.
Since a majority of my practice growth has been based on word-of-mouth, I have believed that to be the best evidence of quality of care I provide. Not surprisingly, I have not, and will not play this never-ending reporting game in the future, thereby risking pay cuts of up to 11 percent in the coming years. I will be forced to opt out of Medicare, based on unproven and ill-conceived programs set up by bureaucrats, thereby reducing access to an endocrinologist in our region, where there is already a substantial dearth of such specialists.
So why does a program that is complex, inefficient, damaging to clinician morale, irrelevant to practice, of little benefit to patients or society, still being pursued by our government? It is time each one of us write to our elected representatives and ask this simple question. The government and its “non-profit” collaborators and cronies are playing a dangerous game with the health of all Americans. I can only hope my patients and my physician colleagues will recognize this danger very soon, and act on it.
Arvind Cavale is an endocrinologist who blogs at Rebel.MD. He can be reached on Twitter @endodocPA.
