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Quality Programs Physicians Should Heed


Do yourself a favor: participate in as many quality programs as make sense for your practice.

The Institute for Healthcare Improvement developed the "Triple Aim," a strategy that helps to optimize health system performance. It includes: Improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Kai Tsai, EVP at Valence Health, a Chicago-based consulting firm specializing in value-based systems, believes there should be a fourth aim. "The fourth one is physician satisfaction. We are asking [physicians] to do so much in terms of learning to build infrastructure, provide better outcomes, provide better quality, and reduce costs," he says. There are many physician-led structures that can help with the necessary infrastructure to grow quality care and support physicians in that process; for example, a Patient-Centered Medical Home.

But even if you practice in a small group, you are probably already reporting quality measures that you can build upon to meet future value-based payment programs. Here are some of the key ones:

1. Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System (PQRS) (bit.ly/quality-reporting) is a quality reporting program that encourages physicians and other eligible providers to report quality measures to Medicare. Starting in 2015, Medicare will assess a penalty of 1.5 percent against Medicare reimbursements for physicians who do not participate in the program, which will grow to 2 percent in 2018. In 2019, payment for quality reporting will be made through MIPS. 

2. Medicare's Value-Based Payment Modifier (VBM)

The Value-Based Payment Modifier (bit.ly/value-pay) was created to reward physicians for achieving quality measures for patients enrolled in the traditional Medicare fee-for-service program. High performance on quality measures can result in payment incentives for providers, while underperformers may receive a negative adjustment.

3. CMS EHR Incentive Programs (Meaningful Use)

The CMS EHR Incentive Program (bit.ly/EHR-pay), Medicare and Medicaid, was created under the HITECH Act to incent physician practices to adopt electronic health records. The Medicare program started in 2011 and will run through 2016. In order to receive incentive payments for meeting successive criteria for Stage 1, Stage 2, and Stage 3 of meaningful use (Medicare), providers must have started in the program by 2014.

4. Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Quality care is not just about clinical measures and outcomes. The government believes that patient satisfaction with healthcare providers is important too. Independent practices with less than 50 providers will be required to report CG-CAHPS survey scores (bit.ly/patient-satisfy) to Medicare beginning in 2017.

5. Medicare Shared Savings Program (MSSP)

The Medicare Shared Savings Program (bit.ly/shared-save) was established through the Affordable Care Act. It was intended to facilitate care coordination between providers, improve the quality of patient care, and reduce unnecessary costs in the delivery of healthcare. Physicians and health systems participate in this program through an Accountable Care Organization (ACO).

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