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Health Policy Basics: Physician Quality Reporting SystemHealth Policy Basics: Physician Quality Reporting System

Michelle K. Koltov, MPH; and Nitin S. Damle, MD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 24 June 2014.

From American College of Physicians, Washington, DC, and South County Internal Medicine, Wakefield, Rhode Island.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0786.

Requests for Single Reprints: Michelle K. Koltov, MPH, American College of Physicians, 25 Massachusetts Avenue NW, Suite 700, Washington, DC 20001; e-mail, mkoltov@mail.acponline.org.

Current Author Addresses: Ms. Koltov: American College of Physicians, 25 Massachusetts Avenue NW, Suite 700, Washington, DC 20001.

Dr. Damle: South County Internal Medicine, 481 Kingstown Road, Wakefield, RI 02879.

Author Contributions:Conception and design: M.K. Koltov, N.S. Damle.

Analysis and interpretation of the data: M.K. Koltov, N.S. Damle.

Drafting of the article: M.K. Koltov, N.S. Damle.

Critical revision of the article for important intellectual content: M.K. Koltov, N.S. Damle.

Final approval of the article: M.K. Koltov, N.S. Damle.

Administrative, technical, or logistic support: M.K. Koltov, N.S. Damle.

Collection and assembly of data: M.K. Koltov, N.S. Damle.

Ann Intern Med. 2014;161(5):365-367. doi:10.7326/M14-0786
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The U.S. health care system is in the midst of transforming from a fee-for-service system to a value-based system that delivers high-quality and cost-effective care. Quality reporting programs and increasing transparency of performance are meant to encourage physicians and hospitals to invest in improving the delivery of care. In 2006, the Centers for Medicare & Medicaid Services implemented the Physician Quality Reporting System (PQRS). The PQRS is an incentive and penalty payment program for eligible professionals who report data on quality measures for covered professional services furnished to Medicare beneficiaries. The program gives eligible professionals the opportunity to assess the quality of care they are providing to their patients and compare their performance on a given measure with that of their peers. This article discusses the history of PQRS, the 2014 PQRS, and how it affects other quality programs.





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Submit a Comment/Letter
Posted on September 24, 2014
Yoel Drucker MD
Sarasota Arthritis Center
Conflict of Interest: None Declared
Kotlov and Damle (1) report that the Physician Quality Reporting System (PQRS) that began in 2006 and is now permanent is supposed ,among other goals, to help transforming payments towards a “value based“ system and that CMS will report to the public on specific measures collected by specific providers.
However, the article is unclear about whether this reporting will be solely what measures specific providers reported, or if it will also include how the provider “scored” on these measures.
As a Rheumatologist, I am familiar with the PQRS measures relating to Osteoporosis and Rheumatoid Arthritis, and noticed that some of the measures have become flawed due to failure to update them over time.
Measure # 41 looks at the percentage of patients age >50 with the diagnosis of Osteoporosis that are prescribed a FDA approved pharmacologic treatment. Reviewing the treatment options list that is specified in the measure, both Zolendronic acid (approved in 2009) and Denosumab (approved in 2010) are missing . A practitioner that prescribes these medications may not be considered providing quality care due to failure of the system to update the measure since it was introduced years ago.
Both measures #39 and 40 look at different angles of Osteoporosis treatment yet share the same outdated medications list so are also partially flawed.
Additionally, Measure # 176 looks at the percentage of adult patients with Rheumatoid Arthritis that were screened for Tuberculosis within 6 months prior to receiving a 1st dose of a biologic DMARD. The list of biologic DMARDs that appear in this measure is partial and does not include 3 biologic agents that were approved since 2009.
Kotlov and Damle report that considerable effort is invested in developing the measures. However, as shown in the above examples, there is a significant problem regarding the maintenance of some measures. They appear to be copy and pasted from year to year. Overtime, some lose their validity.
Until the time in which such oversights are corrected promptly and a mechanism to reevaluate the measures in a timely manner is put in place, CMS should refrain from reporting individual physician’s score on these measures as a corollary to “quality practice”. Moreover, a perverse incentive for physicians to use older, potentially less effective medications may become a problem, as physicians will prefer those that appear in the measures in an effort to score higher thus damaging quality care.

1. Kotlov M.K., Damle N.S.:Health Policy Basics: Physician Quality Reporting System. Ann Intern Med 2014;161: 365-367. dol:10.7326/M14-0786
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