The Centers for Medicare and Medicaid Services (CMS) has signaled that there will be significant changes for physicians in 2014. In a proposed rule published July 6, CMS addressed many issues. This article discusses two topics covered in the proposed rule: the Physician Compare website and electronic health records.
Physician Compare website
Physician Compare is a website that provides information on physicians enrolled in the Medicare program, as well as other eligible professionals participating in the Physician Quality Reporting System (PQRS). The website is required by Section 10331(a)(1) of the Affordable Care Act. To the extent that scientifically-sound measures are available, the site must include: (a) measures collected under the PQRS; (b) an assessment of patient health outcomes and functional status of patients; (c) an assessment of the continuity and coordination of care and care transitions; (d) an assessment of efficiency; (e) an assessment of patient experience and patient, caregiver and family engagement; and (f) an assessment of the safety, effectiveness and timeliness of care.
In addition, CMS must also allow physicians and other professionals whose information is being publicly reported to have a reasonable opportunity to review their results before posting. As previously finalized, this will consist of a 30-day preview period for all measurement performance data. CMS will provide details of the review process on the Physician Compare Initiative page on CMS.gov.
Currently, users of Physician Compare can search for Medicare physicians and other health care professionals by entering a location; a specialty, health care professional or group practice name; and a medical condition, body part, or organ system. The American Medical Association (AMA) has criticized the search function, noting that the results may come back with the searched-for medical specialty at the bottom of the list. For example, the AMA noted in a letter to CMS that if a patient enters the query “plastic surgeon” into the search field and enters the zip code 33602 within a 10-mile radius, the first groups to appear are family practice, general practice, geriatric medicine, internal medicine and primary care health care professionals. The most relevant specialty, plastic and reconstructive surgery, is listed at the end, the AMA noted.
Under a rule already finalized, Physician Compare will include performance information on diabetes mellitus and coronary artery disease. The information that will be posted is data that was reported in 2013 via the group practice reporting option (GPRO) Web interface that meets the minimum sample size of 20 patients and that proves to be statistically valid and reliable. CMS expects to publish such information in late 2014, if technically feasible.
Under the proposed rule, CMS would expand the quality measures reported. In 2014, these would include all measures collected through the GPRO Web interface for groups of all sizes participating in 2014 under the PQRS GPRO and for accountable care organizations participating in the Medicare Shared Savings Program. This data would include performance on measures reported that met the minimum sample size of 20 patients and that prove to be statistically valid and reliable. CMS also proposes to report, no earlier than 2015, performance on certain GPRO registry and electronic health record measures that can also be reported through the GPRO Web interface in 2014.
Under a previously finalized rule, CMS will post performance information on patient experience survey-based measures from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) for group practices of 100 or more eligible professionals participating in the PQRS GPRO and reporting data through the GPRO Web interface. This would include the following measures: getting timely care, appointments and information; how well your doctors communicate; patients’ rating of doctor; access to specialists; and health promotion and education. These will be posted on Physician Compare in 2014 for data collected in 2013. CMS will administer and collect patient experience survey data on a sample of the group practices’ beneficiaries.
For ACOs in the Shared Savings Program, CMS will report similar patient experience data. This will include the same measures as above in addition to two other measures: shared decision-making and health status/functional status. CMS will administer and collect the data.
CMS proposes to encourage groups of 25 or more to report CG-CAHPS by making these measures available for reporting the PQRS and for the value-based payment modifier. The agency also proposes to report CG-CAHPS data in 2014 for any group practice, regardless of size, that voluntarily reports. However, CMS would not fund the surveys for these groups.
Electronic Health Records
The proposed rule includes two reporting options for eligible professionals that are intended to align reporting requirements and minimize the reporting burden. In addition, the proposed rule addresses reporting rules for electronically-specified clinical quality measures (CQMs).
• Qualified clinical data registry reporting option.
First, the proposed rule would allow eligible professionals to submit CQM information for meaningful use in the Medicare Electronic Health Records (EHR) Incentive Program through qualified clinical data registries. This option would begin in 2014. CMS notes that the proposed criteria for participation in a qualified clinical data registry for the 2014 PQRS incentive are similar to the criteria for meeting the CQM component of meaningful use. The qualified clinical data registry reporting option would only be available for eligible professionals who are beyond their first year of demonstrating meaningful use.
Additional criteria for an eligible professional who seeks to report CQMs using a qualified clinical data registry would be: (a) the eligible professional must use certified EHR technology (CEHRT) as required under the Medicare EHR Incentive Program; (b) the CQMs reported must be included in the stage-two final rule and use the same electronic specifications established for the EHR Incentive Program; (c) the eligible professional must report nine CQMs covering at least three domains or, if an eligible professional’s CEHRT does not contain patient data for at least nine CQMs covering at least three domains, then the eligible professional must report the CQMs for which there is patient data and report the remaining CQMs as “zero denominators” as displayed by the CEHRT; and (d) an eligible professional must have CEHRT that is certified to all of the certification criteria required for CQMs. Finally, the clinical data registry would have to be certified for the functionality that it is intended to fulfill and be a certified EHR module that is part of the eligible professional’s CEHRT.
CMS also noted that it intends to revisit the certification criteria in the stage-three rulemaking in order to develop a more flexible clinical data registry reporting option and certification criteria for the EHR Incentive Program.
• Proposed group reporting option: comprehensive primary care initiative.
Second, the proposed rule includes a group reporting option for CQMs for the Medicare EHR Incentive Program for eligible professionals who are part of a Comprehensive Primary Care Initiative practice site that submits at least nine electronically-specified CQMs covering three domains. This option would begin in 2014.
Under this option, each of the eligible professionals in the practice site would satisfy the CQM reporting component of meaningful use for the relevant reporting period if the practice site meets the reporting requirement of the Comprehensive Primary Care Initiative. However, only eligible professionals who are beyond their first year of demonstrating meaningful use would be permitted to use this reporting option. Further, the practice site would be required to submit the CQM data in the form and manner required by the Comprehensive Primary Care Initiative.
If the practice site failed to satisfy these requirements, eligible professionals who are part of the site would have the opportunity to report CQMs under the EHR Incentive Program’s stage-two final rule for the program beginning in 2014.
• Reporting of electronically-specified CQMs.
CMS proposes that eligible professionals who seek to report CQMs electronically under the EHR Incentive Program be required to use the most recent version of the electronic specifications for the CQMs. The agency also proposes that eligible professionals be required to have CEHRT that is tested and certified to the most recent version of the electronic specifications for the CQMs. Eligible professionals who do not wish to report CQMs electronically using the most recent version could report CQM data to CMS by attestation for the EHR Incentive Program.
Vasilios J. Kalogredis is the president and founder of Kalogredis, Sansweet, Dearden and Burke, a health care law firm in Wayne, Pa. He can be reached at 610-687-8314 or at BKalogredis@KSDBHealthlaw.com.