BALTIMORE — Outcomes registries, not claims data, should be the base for the Physician Quality Reporting Initiative next year, physicians and their representatives said at a forum held in May by the Centers for Medicare and Medicaid Services.
CMS officials said they are gathering comments on how to evolve from claims-based information to a registry model, to prevent duplicative efforts to collect data and to encourage quality improvement. The agency's final recommendations will be published in the Federal Register in mid-August as a proposed set of 2008 reportable measures, agency officials said.
A Department of Health and Human Services spokeswoman said that more than 600 people participated in the forum via conference call. The initiative was mandated as part of the Tax Relief and Health Care Act of 2006. Beginning in July, physicians can take part in the initiative by reporting on specialty-specific measures. This year, CMS has listed 74 measures (posted at www.cms.hhs.gov/PQRI
To participate, physicians submit data on those measures through December on at least 80% of their cases. Those who participate will get a bonus lump-sum payout of 1.5% of claims submitted, some time in mid-2008.
Many physicians already report on such measures to specialty societies.
The longest-running registry is maintained by the Society of Thoracic Surgeons. The 17-year-old registry contains more than 3 million records, Dr. Jeffrey Rich of the STS said at the forum. He noting that registries allow for the collection of clinical data on patient outcomes, which is more useful for quality improvement.
STS suggested that outcomes measures should be vetted through groups such as the American Medical Association's Physician Consortium for Performance Improvement and the AQA (formerly the Ambulatory Care Quality Alliance).
Measures that cut across disciplines should be harmonized, preferably by the National Quality Forum, Dr. Rich said. In addition, input standards should be established to ensure that the data cover all patients, not just a random sample, and finally, registries should be subject to validation and an audit mechanism, he noted.
CMS also heard about the registries of the American Osteopathic Association, the Wisconsin Collaborative for Healthcare Quality, users of GE Healthcare's electronic medical records, the American Medical Group Management Association, and the American Society of Plastic Surgeons.
Jean Harris of the American College of Surgeons said that organization is exploring registry development through the Surgical Quality Alliance. The American Board of Neurological Surgery has developed 15 procedure-specific outcomes measures that are available online, said Dr. Robert Harbaugh of the American Association of Neurological Surgeons.
In 2006, the American Board of Internal Medicine began requiring internists to begin using Practice Improvement Modules (PIMs) in order to maintain certification. With PIMs, physicians enter medical data about patients, and then receive reports back from ABIM, which they are supposed to analyze and use to develop a self-improvement plan.
The American College of Physicians was due to make a statement at the forum, but a representative on the conference call said the group decided it was not ready to share its thoughts on registries and PQRI.