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AAOS Now

Published 8/1/2007

Specialists call for testing, evaluation of quality measures

Alliance of Specialty Medicine poll shows concern about effectiveness, impact of current programs

Nearly 85 percent of medical specialists responding to a poll said that the quality reporting measures in the Centers for Medicare & Medicaid Services’ (CMS) Physician Quality Reporting Initiative (PQRI) must be tested and evaluated before the program is expanded or made permanent.

“Physicians want to provide the very best quality care and participate in this process, but this new federal process will only work if physicians have the time to prepare and the measures are proven,” said E. Anthony Rankin, MD, AAOS first vice president.

“The PQRI is just beginning and should be thoroughly assessed after its completion in December 2007 and before any other program is instituted,” said Dr. Rankin. “We need to assess the level of participation, the barriers to participation, and whether the correct measures were used, among others issues, before moving forward.

Survey results
The following are among the most significant
results of the survey:

  • Nearly all (97 percent) of respondents identified “medical societies/physicians” as those best suited to develop quality measures.
  • Although 60 percent of respondents currently report on hospital quality measures, an almost equal number do not plan to participate in the current PQRI initiative.
  • More than 90 percent of respondents said it was “critical” or “important” to determine if the quality measures are effective before implementing a mandatory reporting system.
  • More than 90 percent of respondents said it was “essential/vital” or “important” that specialty physicians be involved in developing federal quality measures for that specialty.
  • Almost 80 percent of those responding had concerns that a pay-for-performance system could harm the quality of patient care.
  • Nearly half (44 percent) of respondents reported that access to specialty care by residents in their state to specialists in their specialty had declined in the past year.
  • Low Medicare payments, fewer doctors accepting Medicare patients, and an exodus of doctors from states were the top three reasons cited for the decline in access.

Other Concerns
Those polled also expressed other concerns about the PQRI system, including the following: increased focus on measures may harm quality of care in other areas (41.6 percent); too much emphasis on reducing costs may reduce services for patients or harm quality of care (36.6 percent); reporting will increase administrative burden on practices and the cost of care (36.3 percent); and no clear process exists for developing and reporting the measures (27.2 percent).

The poll of more than 2,000 medical specialists was conducted from June 18 to July 6, 2007, by the Alliance of Specialty Medicine, a federal healthcare policy organization based in Washington, D.C. Medical specialty groups participating in the poll included the AAOS, the American Association of Neurological Surgeons, the American College of Emergency Physicians, the American Society of Cataract and Refractive Surgery, the American Urological Association, and the Congress of Neurological Surgeons.

About the PQRI
The voluntary PQRI program went into effect on July 1, 2007. The program, for which Congress set aside $1.35 billion, is part of the Tax Relief and Health Care Act of 2006.

“The new Voluntary Medicare Quality Reporting Act (HR 2749, S 1519), a bipartisan measure introduced in both the House and the Senate, presents a common-sense approach to moving forward on pay-for-performance” said Dr. Rankin. “This Act is supported by the Alliance of Specialty Medicine, which lobbied for it on Capitol Hill on July 12.”

In meetings with staff from key Congressional committee leaders, the Alliance found that nearly all offices seemed interested in the legislation and willing to support a more reasonable and deliberate approach to physician quality reporting.

A copy of the full report is available by contacting Laura Gore at the American College of Emergency Physicians at lgore@acep.org, or by calling her at (202) 728-0610, ext. 3008.