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E. Anthony Rankin, MD, AAOS first vice president, addressed reporters during the Alliance of Specialty Medicine’s lobby day in support of the Voluntary Medicare Quality Reporting Act of 2007.

AAOS Now

Published 8/1/2007
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Kate Mevis

Medicare reporting program must truly promote quality

AAOS requests that members of Congress introduce and support “The Voluntary Medicare Quality Reporting Act of 2007”

During the past year, a legislative provision in the “The Tax Relief and Health Care Act of 2007” (TRHCA) formalized the concept of pay-for-performance. Signed into law in December 2006, TRHCA codified the Physician Quality Reporting Initiative (PQRI), which went into effect on July 1, 2007.

Participation and reporting through PQRI is voluntary for the first 6 months (through December 2007). Physicians who report on three preestablished measures in at least 80 percent of Medicare claims will receive a bonus payment of up to 1.5 percent of their total Medicare payments. Orthopaedic surgeons can select from nine measures, including the following: timing and administration of antibiotics, deep venous thrombosis prophylaxis, and osteoporosis screening and treatment. (Detailed information on the performance measures can be found on the Centers for Medicare & Medicaid Services [CMS] Web site: www.cms.hhs.gov/PQRI and on the AAOS Web site at www.aaos.org/PQRI.)

A permanent reporting program is set to continue on January 1, 2008. The law is silent, however, on bonus payments for 2008 and beyond. Similarly, TRHCA does not outline a well-established process for measure development.

Introducing an alternative
The American Association of Orthopaedic Surgeons (AAOS) and organizations within the Alliance of Specialty Medicine (Alliance) believe that a reporting program affirming that physicians provide the highest quality of care to patients is unnecessary. If a reporting program is to be implemented, however, it should truly promote quality. The current PQRI program reflects Congressional haste rather than a well-structured, detailed program description.

The Alliance is contacting members of Congress and requesting their support for The Voluntary Medicare Quality Reporting Act of 2007 as an alternative that provides a realistic process for developing quality measures and implementing a reporting program. Sens. Ben Cardin (D-Md.) and Arlen Specter (R-Pa.) introduced the legislation in the Senate; Reps. Bart Gordon (D-Tenn.) and John Shadegg (R-Ariz.) introduced it in the House.

If passed, The Voluntary Medicare Quality Reporting Act of 2007 would promote the establishment of an appropriate timeline for implementing a permanent reporting program and a well-defined measure development process. The legislation would require the Secretary of the Department of Health and Human Services to evaluate data from the current voluntary reporting period and inform Congress of the initiative’s successes and failures by June 1, 2008. Physicians would be able to see the results of reporting and alter their practice patterns accordingly. A permanent voluntary Medicare quality reporting system would be phased in over a 15-month period, beginning Jan. 1, 2010.

Developing quality measures
Because TRHCA—the legislation that created the PQRI—does not include adequate guidelines for developing quality measures, Alliance members are concerned that CMS, which is responsible for implementing reporting measures for the Medicare program, will accept quality measures that are not vetted through a consensus organization. Thus, The Voluntary Medicare Quality Reporting Act of 2007 establishes a transparent, multistakeholder process. This process would include all providers in determining clinical areas for measure development and in creating quality measures. The Act would mandate that all measures be developed through the American Medical Association’s (AMA) Physician Consortium for Performance Improvement (PCPI).

The AMA PCPI engages all major stakeholders—including the AAOS as a participating member—in the measure development process. The measures would then be endorsed by the National Quality Forum before being implemented by CMS.

The Voluntary Medicare Quality Reporting Act of 2007 also establishes a registry for data collection. Alliance members included the registry provision in the legislation in anticipation that measures will move from being process-oriented, as they are currently, to outcome-based.

Impact on physicians
Because of the enormity and complexity of such a reporting program, implementation must be incremental; reporting should not affect patients’ ability to see their physicians. Until outcome-based measures are developed, AAOS supports data collection based on process measures. This will enable physicians to acclimate to added administrative tasks and learn how to report.

Health information technology, a resource that could ease the burden of reporting for physicians, also requires considerable time and money to implement. CMS and Congress need to realize that these additional burdens on physicians may affect access to care.

The AAOS and the Alliance continue to meet with key Senate and House committee members and their staffs in a strategic attempt to shape future debates on the Medicare program. Interest in the legislation is high, showing a willingness to support a more cogent and deliberate approach to physician quality reporting.

You can help by contacting your congressional representatives, expressing your concerns about the current reporting program, and encouraging their sponsorship of The Voluntary Medicare Quality Reporting Act of 2007. For more information on how you can get involved, visit the government relations section of the AAOS Web site, www.aaos.org/dc.

Kate Mevis is a legislative assistant in the AAOS Washington, D.C., office of government affairs. She can be reached at kmevis@aaos.org.