Payors address quality reporting for 2008

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Daniel H. Green, MD, FACOG, spoke to payors about the need to expand sources of health data for the purposes of quality reporting, as well as lessons learned from the Physician Quality Reporting Initiative (PQRI) for 2007, at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS) held in Orlando this week.

“The status quo is no longer acceptable,” said Green, from the Office of Clinical Standard and Quality within the Centers for Medicare & Medicaid Services (CMS). “Quality is at the core of the physician-patient relationship and the opportunity is now to keep the focus on quality.”

In December, President George W. Bush signed the Medicare, Medicaid, and SCHIP Extension Act of 2007, which authorized the continuation of the PQRI for 2008. The reporting period began Jan. 1.

According to Green, the financial incentive for eligible professionals who successfully report the designated set of quality measures during 2008 is 1.5 percent of total allowed charges for covered services payable under the Physician Fee Schedule. 

There are 119 quality measures in the PQRI for 2008, including two structural measures.  One structural measure conveys whether a professional has and uses EHRs, and the other is e-prescribing.

Green said that CMS learned valuable lessons from the results from the 2007 PQRI, which include the need for a good website and transparency of information.

Communication between stakeholders should occur often and it is important to recognize that each audience requires different information and technical support, he added. As a final mention, he said strategies around information, decisions, process design, implementation and trouble-shooting need to be reassessed and modified as needed as quality reporting initiatives move forward.

Additional reporting options proposed to the PQRI 2008 include registry-based reporting and EHR-based reporting, he said.

CMS will test two options for registry-based reporting in 2008, one of which is for registries to collect and send claim information, which CMS will then calculate reporting/performance rates. The second option is for the registry itself to calculate reporting/performance rates and send that information to CMS.

The testing will allow CMS to validate registry data for the first year, he said.

Green rounded out the presentation with an open forum of members from the private and public sectors, sparking dialog among attendees on quality reporting and issues specifically relevant to their personal perspectives.

Robert Kolodner, MD, national coordinator, Office of National Coordinator for Health Information Technology, participated as a panelist in the forum. He stressed the importance of providers and payors working together to improve quality care and quality reporting.

“The actions that are working are the things in the community that involve multistakeholders,” he said. “In this case, it is cost and quality. We are looking for systemic cost reductions without sacrificing quality.”