BOSTON - While a room full of attendees sat down to lunch, a panel of speakers provided updates on the Physician Quality Reporting Initiative (PQRI) and the Centers for Medicare and Medicaid Services (CMS) new efforts to improve the quality of healthcare and control costs at the Health Policy Socioeconomic Luncheon during the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).
The luncheon focused primarily on providing an overview of the appeal process for local Medicare contractors, an update on PQRI and how data is used and processed for new technology reviewed by ASTRO’s Emerging Technology Committee.
Bernard Rosof, MD, from North Shore Long Island Jewish Medical Center Hospital in Great Neck, N.Y., and one of the three presenters, explained to attendees how CMS uses data for tracking with regard to quality and the potential effect it has on reimbursement.
He said that in the overall quest to create a more reliable healthcare system, no one is addressing the cost of developing performance measures and the implementation of such measures. While the costs are considerable, on the implementation side, in small offices, the costs are being driven up considerably, he noted. Additionally, in regards to developing the measures, he said that “we need evidence-based guidelines, and unfortunately, there are very few. The demand for performance measures out risks the desires to have the measures developed because we don’t have the measures in many situations.”
Rosof outlined the need to start with a quality framework for PQRI, which he said comes in the form of the national quality forum.
“The issue right now is how to coordinate care adequately throughout the continuum,” he said. “The current state of performance measurement is a cacophony of well meaning but uncoordinated signals. National priorities will help align strategies of multiple groups around common goals for improvements and will drive fundamental change in the delivery system.”
CMS strategies are to work through partnerships, measure quality and report comparative results, value-based purchasing (VBP), improve quality and avoid unnecessary costs, encourage the adoption of health IT and promote innovation and the evidence base for effective use of technology, he added.
“The goals are to improve quality, reduce costs, make performance results transparent in order to empower the consumer to make value-based decisions about their healthcare and to encourage hospitals and clinicians to improve quality of care as you know it today,” he said.
Ultimately, the end goal of CMS initiatives such as VBP, pay-for-reporting, pay-for-performance and competitive bidding, are to improve quality and avoid unnecessary costs.
Medicare fee-for-service schedule and prospective payment systems are based on resource consumption and quality of care, he said. “It’s not based on quality or unnecessary costs avoided; but that is what they [CMS] are aiming for as we move forward, especially since payment system incentives clearly are not aligned.”
There is clear variation in the way medicine is practiced in the United States, he noted, even from state to state, the costs and the quality of care varies for the same services. For example, a coronary artery bypass graft procedure in southeast Florida is double the cost for the same procedure performed in Minneapolis, yet the outcomes in Minneapolis seem to be better.
“If you compare our results to results around the world, for example Europe and other parts of Asia, we spend more and our quality of certain metrics is not as good – this is something that needs to be changed and that is what CMS is attempting to do in their new efforts. We need to move in a direction that puts more efficiency into healthcare,” Rosof said.
He recommended looking at emerging models of provider payment reform, citing a Sept. 19 perspective in the New England Journal of Medicine by Meredith Rosenthal as a good place to start.
Rosof stressed the importance of understanding the principles of performance measurements and the need to educate staff on reportable measures for each subspecialty. “If there is no measure present that can be reported on for your subspecialty, how can you get payment for reporting it?”