A little-noticed provision of the health reform law will let physicians use data collected and reported as part of the maintenance of certification process as an alternative to the Medicare Physician Quality Reporting Initiative.
The details have yet to be worked out, but it would mean that physicians likely would have at least one fewer process to report quality data, said Dr. Christine Cassel, president and CEO of the American Board of Internal Medicine.
The advantage of the maintenance of certification (MOC) process is that physicians are familiar with it, as more than 80% of all physicians participate, Dr. Cassel said in an interview.
Physicians have been eligible to receive bonuses for participation in the Medicare PQRI, but they have complained about it as a redundant, burdensome, and confusing process, and have bemoaned botched or missing payments. Even the Centers for Medicare and Medicaid Services has acknowledged problems with the program.
In a statement, Dr. Kevin B. Weiss, president and CEO of the American Board of Medical Specialties, said that “MOC reporting will give patients, health plans, and others the information they need to choose physicians based on performance and other key qualifications, including diagnostic acumen, clinical reasoning, and medical knowledge. This [law] is a significant step forward in recognizing the value of MOC in advancing health care quality for the benefit of patients.”
Under the Patient Protection and Affordable Care Act of 2010—one of the two major health reform laws—the Health and Human Services secretary will decide how MOC will fit into the PQRI process. The hope is that this will be clarified within the year, ABIM's Dr. Cassel said.
ABIM and other medical specialty boards seek to meet with CMS officials to help write the regulations for implementing the process, she said. “Our concept is that it would be kind of an alternative pathway … that it would include all the same conditions and measures as PQRI, but be even more comprehensive,” said Dr. Cassel.
Family physicians already have some experience with using MOC as an alternative to PQRI. The American Board of Family Medicine received approval from Medicare to use its MOC registry for the PQRI process, according to Dr. Michael Hagen, ABFM's senior vice president. Instead of using Medicare “G” codes, physicians report actual patient data.
In 2008 (the first year of the registry), 260 family physicians participated. Participants could report on 15 patients over a 6-month period to receive half of the bonus, or 30 patients over a year to receive the full bonus, Dr. Hagen said in an interview. Last year, all participants were required to report on the full year; about 720 family physicians participated, he said.
Dr. Hagen said that he doesn't expect the ABFM process to change anytime soon. “Our PQRI process will continue as it is until we see the final rules and regulations” regarding implementation of the new law.
Dr. Hagen said that he envisions a future in which physicians can submit data for PQRI, for MOC, and for meaningful electronic health records in one fell swoop.
This Month's Talk Back Question
How confident are you that maintenance of certification data can be adapted to accommodate the PQRI process?