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Quality Management in Health Care

by Steven Zeldes, MD

In his blog on December 8th, 2015, Dr. Camellus Ezeugwu encouraged patients to ask their physicians for their “quality management record” to ensure high-quality care. My response to Dr. Ezeugwu is: Please don’t ask your ophthalmologist for their “quality management record.”   According to Medicare, we are all average or below!  Instead, please ask your Congressmen to rethink their calculations.

Section 3007 of the Affordable Care Act mandates that by 2015, CMS must begin applying a Value Modifier under the Medicare physician fee schedule. CMS is phasing in the Value Modifier gradually to different sizes of physician groups.  In it, the Physician Quality Reporting System (PQRS), a pay-for-reporting program, uses a combination of incentive payments and downward payment adjustments to promote reporting of quality. 

I have an electronic medical record, a patient portal, and with the help of athenahealth, have always received my full incentive payments.  I also feel like I provide quality and low-cost care.  In 2015, I participated in PQRS and submitted my measure in three registries, not just the one required by Medicare.  I monitored my progress throughout 2015 and seemed to be getting high marks.  High quality, here I come!  For my compliance, I expected at least a 2% increase in my Medicare payments.

It’s now 2016, and I just looked at my Meaningful Use dashboard.  To my surprise, I am average quality!  Two of my measures were 100%, but “average” according to CMS.  One was 98%, but average.  And another  86%, but also average.  How can this be?  Isn’t 100% perfect?  Certainly it’s above average?  What is going on here? 

It appears the Ophthalmology benchmark mean is nearly 100%. It’s impossible, therefore, to qualify as high quality for my specialty.    Are we too good at reporting?  I think it’s time for Medicare to rethink how they determine “high quality,” at least for eye doctors (and probably your specialty too).

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Submitted by Brian Crownover MD - Friday, June 17, 2016

Seems less carrot (incentive payments) and mostly stick (downward payment adjustments) is all they believe in now.....

Submitted by Robert D Peterson M.D. - Friday, March 4, 2016

I believe the obvious conclusion is that CMS's goal is to decrease the quality of care all patients receive, and this is an excellent demonstration of them attempting to meet that goal.

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