The always interesting topic of the appropriateness of federal quality and safety benchmarks is getting some extra attention this year. A major shift is taking place in Medicare's Physician Quality Reporting System program, while the National Quality Forum is examining a group of relatively unpopular patient safety measures for possible revision.
The Medicare PQRS program beginning this year cut out the payment of incentives to physicians who don’t participate in the program, leaving only the possibility of penalties. While that is no surprise to the field, some physicians — including specialists who work in ambulatory care — continue to be concerned that they will have a difficult time finding measures that realistically can be met.
Some of the worry is driven by changes to the measures that can be used in PQRS reporting. Emergency department physicians face a limited number of choices that can be applied to their specialty. Catherine Polera, chief medical officer for the emergency medicine division of Sheridan Healthcare, says that Centers for Medicare & Medicaid Services removed some of the core measures that may have worked in an emergency department setting and replaced them with ambulatory care measures. The new measures "relate more to primary care than they do critical care," Polera says.
Although primary care measures have some application to the ED, "we see more trauma, we see more chest pain patients, more abdominal pain patients, and I'm not seeing those related measures," she says.
Polera and others would like to see the PQRS program pay closer attention to providing relevant measure for specialty physicians who are required to participate. "It would be ideal if they organized it by specialty and we would have input," she says.
In terms of how the changes affect hospitals, that will vary case by case. "Determining the implications for a hospital is a little more complicated," says Akin Demehin, senior associate director of policy for the American Hospital Association. "It mainly boils down to whether a physician bills for the procedure or whether the hospital bills for the physician. Whoever submits the bill, generally speaking, is going to be responsible for the reporting, Demehin says.
On a note that would be more favorable to the field, the National Quality Forum's Patient Safety project is reviewing a set of federal measures together known as PSI 90 that are used for health care-acquired condition benchmarking. The gauge is based on billing data, which is an inexact barometer of patient safety, Demehin says. "It's not reliable enough," and the AHA is in favor of the NQF revising PSI 90 appropriately on behalf of Health & Human Services.
Update, March 5:
I missed a blog announcement from CMS that they have released a 271-page report that evaluates their quality benchmarks. They conclude that their measures in general are working well.