New Federal Reporting Profiles Physicians and Hospitals

Gail Thompson

April 2013, Vol 3, No 3 - Community Oncology


Orlando, FL—At the Community Oncology Alliance (COA)’s 2013 annual conference on March 22, 2013, David Eagle, MD, from Lake Norman Hematology Oncology Specialists in North Carolina, presented an illuminating program on the rapid growth of federal reporting on physicians and hospitals in the name of quality.

Provocatively entitled, “You Won’t Believe What CMS Will Be Reporting on Your Oncologists,” Dr Eagle presented the challenges and the details of the information that the federal government is now collecting and reporting. Key federal quality initiatives are now involved in comparing hospitals, comparing physicians, and also building quality and resource-use reports as well as a physician value-based payment modifier.

Hospital reporting has been ongoing since 2005, when the Centers for Medicare & Medicaid Services (CMS) launched the “Hospital Compare” website (www.medicare.gov/hospitalcompare), which shows comparative data on approximately 4000 Medicare-certified hospitals. Using data analyses of Medicare patient claims, as well as a patient survey administered by the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospital Compare pre­sents specific measurements intended to provide patients with a platform to compare local hospitals. Detailed reporting is made available on 3 primary categories: timely and effective care (ie, time to treatment for specific diseases); readmissions, complications, and deaths; and the use of medical imaging. Additional information is shared from CAHPS patient surveys on the number of Medicare patients served as well as whether the costs of care to the Medicare program were higher, lower, or about the same compared with other hospitals.

Value-Based Comparison Systems

Like any of the reporting and “grades” programs that have cropped up in recent years for consumer comparisons of healthcare choices, Hospital Compare faces many challenges. Dr Eagle reported on a 2007 study that found that rating systems often varied significantly from each other, and “for any given diagnosis, the ratings demonstrated little overall agreement.” Despite the variation, the fact that reporting and measurement is being done at all does appear to yield some degree of performance improvement for process-of-care measurements and risk-adjusted mortality.

With that marginal success behind them, CMS then turned to a program mandated by the Affordable Care Act (ACA) to create a pay-for-performance program for hospitals. The “Hospital Value-Based Purchasing Program,” which began in October 2012, involves a pool of $850 million set aside for making patient incentives in the initial year. That funding pool will double in 2017.

This program feeds off the data collected and reported in the Hospital Compare database, and it has the potential to redistribute reimbursement from those hospitals judged to be “poor” performers to “higher” performers. Initial payment changes have been calculated to range from -0.25% to +0.25% for affected hospitals. Dr Eagle noted that these rather modest incentives and penalties will probably pale in comparison to the impact on hospitals from the 2% sequester cut, thereby undermining the intent of these performance incentives from their beginning.

After hospitals, physicians moved into the spotlight of federal reporting. The CMS “Physician Compare” website (www.medicare.gov/find-a-doctor) was initially launched in December 2010, but it has been populated with basic information on about 932,000 physicians through early 2013. Current reporting is limited to demographic information, such as name, features, and contact/office information; whether the physician is accepting new Medicare patients; the physician’s training and affiliations; any unique languages spoken; and whether the physician accepts Medicare assignments.

CMS plans to add “robust and reliable quality of care data no earlier than 2014” on the website. The data for the Physician Compare assessments will come from Medicare claims; the Medicare Provider Enrollment, Chain, and Ownership System (PECOS); as well as the results from various physician-reporting programs that are now ongoing (including the Physician Quality Reporting System [PQRS], the e-Prescribing program, the Electronic Health Records Incentive Program, and others). By 2014, CMS plans to include reports of the measures tracked through current group and accountable care organization reports and patient satisfaction surveys for large groups (ie, ?100 physicians). By 2015, it is expected that detailed “quality” data and measures will be available on individual physicians in groups of any size, including the measures developed by specialty societies for individual specialties.

Verifying Reliability

Dr Eagle then addressed the reliability of these public comparison sites. He noted that CMS is supposed to be ensuring that the data supporting the comparisons are statistically valid and include risk- adjustment methodology to reflect an accurate portrayal of a physician’s performance. However, he looked up his own personal information on the Physician Compare website, and explained what he found by saying, “I searched the website for oncology providers within 1 mile of my practice zip code. Of the 7 providers found, none were my partners or myself. When I expanded the search to within 5 miles of my practice zip code, we all appeared, but only 1 of my 2 hospital affiliations was noted and only 1 of my 2 practice office locations. In addition, my specialty was incorrectly listed as “Hematology Oncology.” Dr Eagle highly recommended that physicians check their listings and address any errors by logging into their CMS PECOS accounts now.

The ACA also required that CMS develop a “Quality and Resource Use Report” (QRUR) to provide confidential feedback reports to physicians compiled from Medicare claims data. The QRUR is being phased in and tried with physicians in Iowa, Kansas, Missouri, and Nebraska. The initial purpose of the QRUR is to enable physicians to compare the quality and cost of their care both within their specialty and with all physicians in a geographic region. However, CMS is moving toward ways to pay for quality as an alternative to the current fee-for-service model, and the plan is to use these reports to identify possible components of a payment modifier (that could be used in 2015) to provide differential payment amounts to physicians based on measures of quality and cost. Further details and sample reports for the QRUR are available at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Report Template.html.

The concept of the Value-Based Payment Modifier was first introduced in the 2008 Medicare Improvements for Patients and Providers Act and was expanded in the 2010 ACA. Differential payment for physicians is coming, and it is coming quickly. Each of the activities noted earlier—the launch of the PQRS on top of the current fee-for-service payment model, and the current expansion into Physician Feedback Reporting—are all leading up to this differentiation process for payment.

The Value-Based Payment Modi­fier will first affect physicians in groups of 100 or more in 2015, but by 2017, it will apply to all physicians. The modifier will determine payment to physicians based on quality and cost-of-care measures. More information on this program may be found at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html.

Physicians will soon see their payments directly affected by the information collected and reported about them through not only the CMS Medicare system but, by extension, possibly through private payers as well. The law of averages says that half of all physicians will perform above the average, and half will perform below the average. Soon, that means that half may receive better reimbursement for Medicare patients and half will receive worse reimbursement.

These are matters that are critical to the future of the cancer care delivery system, and to each individual physician in the United States. Making sure that practices and physicians understand the measures against which they are being judged, and the details of the reports now being generated about them and the care they provide, will be an essential practice survival tool, now and in the future. l