Making the Grade in Oncology Care
Just when you thought grade school and report cards were a distant memory, here comes a loud wake-up call. Report cards and grading systems are now (or soon will be) very visible parts of our future as healthcare providers. We may create the scores ourselves, publicize rankings we earn, or be judged by rankings that others place on us. The implications of these new grading systems are going to be significant for our business volume and for the payments we receive for the care being delivered.
In the public arena, consumers are seeking information on care choices and the physicians and centers that provide care options. For years, basic information has been available on the Internet via sites such as www.healthgrades.com, www.zocdoc.com, www.ratemds.com, Angie’s List, and Yelp; or in major magazines and special report publications, such as U.S. News & World Report’s Best Hospitals and Doctor Finder.
The sources for these “reports” are various combinations of available data, surveys, and reviews submitted online from patients and others. Physicians can rarely control what goes on these sites, or even correct errors or outdated information that may appear on them. However, many of these ranking sites are well-funded and pay to have their sites pop up at the top of searches for physicians in different areas and specialties, so that they will easily be seen by consumers. Practices are cautioned to monitor these sites closely and to educate their patients about the veracity and viability of such sites.
Medicare now publishes the websites Hospital Compare and Physician Compare for consumer comparison. This April, Medicare added Hospital Compare Star Ratings, which incorporates information from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey that measures patients’ perspectives on their hospital care. The Physician Compare website currently presents performance scores for groups that voluntarily participated in quality programs such as the Physician Quality Reporting System (PQRS), including the PQRS group practice reporting option; the Electronic Prescribing (eRx) Incentive Program; the Electronic Health Record Incentive Program; and the Million Hearts national initiative.
Medicare intends to build quality-of-care performance scores for physicians who participate in their voluntary quality programs from 2013 forward, but so far there is very little information beyond contact information, education, and board certification for most individual physicians. The public and practices may access the Medicare tracking and reporting at https://data.medicare.gov.
The challenge for practices is that many of the quality reporting elements being developed by Medicare may start out as voluntary but may end up as mandatory, with significant and growing penalties for failure to report, as well as for falling below benchmarks and participation levels.
The hospitals that participated in Medicare quality reporting, the Hospital Value-Based Purchasing (HVBP) program, saw their inpatient reimbursement rise or fall based on their performance on quality and patient experience measures. HVBP-participating hospitals had 1.5% of their calculated inpatient payments withheld in 2015, and will receive a penalty or a bonus according to their total performance score in 4 domains—the clinical process of care, the patient experience of care, outcome, and efficiency. The program is designed so that 50% of the hospitals will receive bonuses and 50% will receive penalties.
Many oncology practices already report that their Medicare volume is very close to the margin and are struggling to manage with the 2% sequestration cuts. Because approximately half of all patients with cancer are covered by Medicare, penalties for performance that result in payment reductions will present a challenge to practices. Practices will gain valuable experience by early participation in Medicare quality programs; performance in those programs is likely to become a measure for financial penalties or bonuses in the near future.
The Center for Advancing Health is reviewing physician report cards (approximately 50 were reviewed in 2013). However, most report cards on physicians focus on résumé-type information (eg, training, certifications, privileges) and very little on quality questions, such as volume experience for procedures, patient outcomes, or other objective quality measures.
Hospitals, cancer centers, and even private practice groups are starting to self-report on their quality measures and experience. Many report about their certification, their patient satisfaction scores, or accreditations as a patient-centered medical home. Self-reporting also adds value by creating a measurement bar that patients and payers can use when comparing service providers.
Payers use internal scoring systems to rank providers. These scoring systems may include the volume of patients, total costs of care profiles, the frequency of procedures, and patient satisfaction, among other ratings. Payer benefit design programs are very likely to support preferred providers. Practices would find it useful to review payer websites annually with insured members of local payers to see how their practice and physicians are ranked between different insurers. If patients see different star ratings for various doctors, or are incentivized with lower copays for provider A versus provider B, that is important information for a practice to know, especially if you are provider B.
So, the question for practices today is not whether you are being graded or ranked, but how often and by whom. Track down your profile on as many payer and physician websites as possible, and pay special attention to Medicare programs. Carrots for voluntary participation are useful, but no one wants to find themselves at the losing end of a stick penalty for nonparticipation or poor performance.