On June 14, ASCRS, in conjunction with the Alliance of Specialty Medicine, met with officials from the Performance-Based Payment Policy Group at CMS to discuss concerns regarding the Value-Based Payment Modifier (VBPM) program and the Quality and Resource Use Reports (QRURs), as well as the Physician Compare website. Representatives from CMS included Dr. Sheila Roman, Senior Medical Officer, Michael Wroblewski, Senior Technical Advisor, and John Pilotte, Director, Performance-Based Payment. At the meeting, specialty society representatives provided feedback to CMS on the recent release of the QRURs to physicians and the associated problems with the reports, emphasizing the difficulty of accessing the reports and stressing that the current methodology analyzes of information attributed to the individual patient, and reports the findings as allocated to the individual physician. Most problematic, all doctors, regardless of specialty, treating a given patient during a specified period of time, will be compared collectively with other groups of physicians. ASCRS used direct feedback provided by ASCRS members who received and reviewed their reports.
As we reported previously, in March, CMS, in conjunction with contractor Washington Physician Services (WPS), emailed physicians in four states a link to an individualized report (“Confidential 2010 Quality and Resource Use Report (QRUR): Medicare Fee-For-Service”). The report provided information about the quality of care provided to Medicare fee-for-service (FFS) patients the physician treated in 2010 (based on PQRS data); the amount Medicare paid the provider for that care; and how the individual provider compared with other Medicare providers within the same specialty. The primary purpose of the reports is to give doctors a preview of how data will be used to adjust Medicare pay for some physicians under a budget-neutral value-based modifier that will take effect in 2015, which means it will not involve additional Medicare funding, so some physicians deemed to be lower performers based on the quality and efficiency of their care will receive reduced payments so higher performing physicians can receive bonuses. CMS has yet to determine which physicians will have the value-based purchasing modifier applied to their payments in 2015. The agency anticipates releasing a proposal this year on how the modifier will work. CMS will be sending out QRUR reports based on 2011 data to the same four states in the Fall.
ASCRS is encouraging doctors to download the reports and provide feedback on the program. Physician input is critical as CMS moves forward with plans to use 2013 Medicare claims to determine bonuses and penalties for selected physicians in 2015. Physicians with questions about specific data within their individual report are asked to email CMS_Medicare_Physician_Feedback_Program@mathematica-mpr.com.
General questions can be directed to Jenny Liljeberg, associate director of regulatory affairs, at jliljeberg@ascrs.org. ASCRS remains opposed to the implementation of the budget-neutral value-based purchasing modifier and has been pushing for the program to be delayed.