Reporting physician quality: The dangerous game the government plays
We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast.
Two recent reports demonstrate how ineffective this program is and how much physicians hate it. Yet, a majority of them are participating in it, purely because they don’t want to be left behind when the train leaves the station. A report from the Medical Group Management Association (MGMA), headlined “Medicare physician quality reporting programs not improving patient quality, needlessly complex,” notes “more than 83 percent of physician practices stated they did not believe current Medicare physician quality reporting programs enhanced their physicians’ ability to provide high-quality patient care” with “more than 70 percent rated Medicare’s quality reporting requirements as ‘very’ or ‘extremely’ complex.” Most concerning from the report is that “a significant majority of respondents indicated these programs negatively affected practice efficiency, support staff time, and clinician morale.”
“Medicare has lost focus with its physician quality reporting programs. Instead of providing timely, meaningful, and actionable information to help physicians treat patients, this has become a massive bureaucratic reporting exercise. Each program has its own set of arcane and duplicative rules which force physician practices to divert resources away from patient care,” said Anders Gilberg, MGMA senior vice president of government affairs, according to this article.
A connected program, maintenance of certification (MOC), sold by the private, non-profit, American Board of Medical Specialties (ABMS) and its affiliates, finds itself as the only certification-type program to be included as an approved PQRS program within the Affordable Care Act. Surely, this MOC program of physician testing and certification can be trusted to assure quality of care? No luck here either. In fact, a recent article in JAMA found that “MOC is perceived by physicians as an inefficient and logistically difficult activity for learning or assessment, often irrelevant to practice, and of little benefit to physicians, patients, or society.”
