Physician Quality Measurements: From Carrots to Sticks

As CMS' bureaucracy morphs meaningful use quality reports to meaningless busywork, it converts quality incentives to penalties to enforce compliance.

There is plenty of commentary on the midterm elections, and you probably don't want to hear more - except for this: As I have read online, offline, and watched, the primary consensus on the Republican “wave” of wins is that the Democrats failed to “get out the vote” instead of being repudiated by voters for failed policies, execution, and competence.

This is no new theme or spin tactic. It has become the norm, particularly in federal government, and officials, elected or appointed, use it from time to time. Here's the case in point. Physicians are squarely in the bullseye of the latest failure grasped from the jaws of success as meaningful use degrades into a redundant, bureaucratic, comply-or-else data reporting program.

The Medical Group Management Association (MGMA) released a report at its recent annual conference in Las Vegas showing more than 83 percent of the over 2,500 respondents said Medicare's Physician Quality Reporting System (PQRS), meaningful use EHR incentive program, and its value-based modifier program, have now become distractions that impede quality improvement.

Meaningful use quality measures, according to Anders Gilberg, MGMA's senior vice president of government affairs, have lost their focus and do not provide the actionable feedback CMS promised.

Gilberg says the programs have become "three silos with multiple penalties," now demanding physicians to report virtually the same information in three different formats. The programs, which started with broad adoption by promising actionable feedback and offering small bonuses for compliance, have become so meaningless, CMS will now punish noncompliance starting in 2015 to force participation.

CMS' decision to bring out the federal paddle because virtually all of the survey participants said they no longer believe that the PQRS program is enhancing their practice is easily avoidable. Tasking a few competent staffers or, better yet, a few primary-care physicians who actually know what will work, and empowering them to make the program relevant again, seems like a more sensible, and simple approach.