CMS Physician Voluntary Reporting Program

Since early 2005, the Centers for Medicare and Medicaid Services (CMS) and Congress-----particularly the House Committee on Ways and Means and the Senate Committee on Finance---have been working to move physicians toward a value-based purchasing system (also referred to as pay-for-performance or P4P) under the Medicare program. CMS is already further advanced in working with hospitals to implement a similar structure where documented reporting on patient care and outcomes may ultimately determine the level of Medicare reimbursement.

Unlike the current hospital reimbursement system, where hospitals receive annual market basket updates not tied to a sustainable growth rate (SGR) formula like what physicians’ face, value-based payments to some physicians would automatically result in decreases to other physicians. AAOS and the Alliance of Specialty Medicine have been advocating that a value-based reward system should only be implemented after fixing the flawed formula under which physicians are already slated to receive negative updates of approximately 5 percent each year until 2013.

CMS initially identified 36 measures---or G codes---as part of a Physician Voluntary Reporting Program (PVRP) designed as a tool to begin encouraging physicians to report these measures as early as January 2006. Working with AAOS and other physician groups, CMS ultimately reduced the number of G codes to a more manageable core starter set of 16 measures to lessen the potential reporting burden, and to encourage more physicians to report.

Confidential feedback reports will be available to physicians on their reporting rate and their performance rate for each of the measures they report on. To receive feedback, physicians must go to the following website to register their intent to participate in the CMS PVRP, although this does not obligate them to participate: www.qualitynet.org/pvrpintent Physicians can submit data on the measures without registering their intent to participate.

Information reported by a registered physician beginning April 1, 2006, will be included in reports back from CMS, expected by December 2006. CMS will further pursue development and refinement of additional measures---including those recommended by physician groups---that will gradually be added to the core list once they have gone through a consensus process and have been endorsed and implemented.

Codes in the starter set applicable to orthopaedic surgery and office-based orthopaedic care include: 1) antibiotic prophylaxis in surgical patient; 2) thromboembolism prophylaxis in surgical patient; and 3) assessment of elderly patients for falls.

The PVRP website can be found at: www.cms.hhs.gov/pvrp . If you have additional questions, please contact Kathryn Pontzer in the AAOS Washington Office, Pontzer@aaos.org, 202/546-4430.