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June 26, 2017

SUMMARY

A new five-star quality rating system for clinicians and group practices will become part of the Physician Compare website in late 2017.  The purpose of the system is to help patients and others make more informed choices.  The ratings will be based on data from the Physician Quality Reporting System in the first year, and, in later years, draw on results from the Merit-Based Incentive Payment System (MIPS).  The best way for anesthesia and chronic pain providers to stay ahead of this rating system is to report quality feedback through a QCDR, manage any outliers identified in their group, and remain vigilant in their reporting.

In late 2017, the Centers for Medicare and Medicaid Services (CMS) will implement a new benchmark and five-star quality rating system for clinicians and group practices on Physician Compare, the website mandated by the Affordable Care Act (ACA) to help patients, families and caregivers make more informed choices regarding healthcare services.  The changes will ramp up the level of information readily available to patients and others about clinician and group practice performance on clinical quality measures, and push healthcare providers, including anesthesia providers and pain specialists, into a new phase of accelerated transparency.  Healthcare consumer sites such as Healthgrades and Vitals are likely to incorporate the information into their own portals.

The new rating system will initially draw from data available through the 2016 Physician Quality Reporting System (PQRS) and Qualified Clinical Data Registries (QCDRs).  In subsequent years, the platform will use data from the Merit-Based Incentive Payment System (MIPS) (mandated by the Medicare Access and CHIP Reauthorization Act of 2015 [MACRA]), which replaces the PQRS, as well as data on non-MIPS QCDR measures. 

In this sense, “beyond substantially tying payment to physician performance, MACRA accelerates and amplifies a potentially even greater factor in the long-term health of a provider organization: its public reputation,” writes consultant Tom S. Lee in an article on the website of the Healthcare Financial Management Association.  As a result, it behooves anesthesia and pain practitioners to be aware of what is coming on the site.

As Elizabeth A. Quill, JD, and Matthew T. Popovich, PhD, put it in a 2015 ASA Monitor article, “public reporting of quality measures and displaying of demographic and educational background data of physicians is not going away anytime soon.”

Despite the trend toward transparency, Quill and Popovich note that public use of Physician Compare has been on the sluggish side.  “The website has not been as popular with consumers as other health grading websites,” they write.  “This may be because patients cannot easily understand the significance of the quality information.  For example, if an individual is listed as participating in the PQRS and the Electronic Prescribing Incentive Program (eRx), patients must navigate to a different webpage where they must explore each individual program for more information.”

Still, the desire among patients for information on clinicians is there, particularly as more patients have shouldered more of their own healthcare costs.  Lee cites a 2014 survey published in the Journal of the American Medical Association showing that 65 percent of patients were aware of physician-rating websites and that 36 percent had used one of the sites at least once.  The pending modifications to Physician Compare, including efforts to make the site more accessible and navigable, are likely to attract more users.

Changes on the horizon will give clinicians and groups who meet or exceed the benchmark for a given measure a five-star rating.  The platform will employ a benchmarking methodology known as the Achievable Benchmark of Care (ABC™ Benchmark), which will enable patients and providers to review the performance of group practices and individual clinicians on specific quality measures.  According to CMS, the new rating system’s goal is to help consumers compare quality differences among providers.

CMS believes a benchmarked system will help users understand performance scores by providing context for those scores and a point for comparison, CMS health policy analyst Alesia Hovatter noted in a recent webinar.

The ABC™ Benchmark methodology, explained in detail in the 2016 Physician Fee Schedule, involves a four-step process that:

  1. Ranks clinicians from highest to lowest performance score for a specific measure and reporting mechanism.
  2. Selects the top subset of clinicians representing at least 10 percent of the eligible patient population for that measure.
  3. Calculates the number of patients receiving the intervention or desired level of care, or achieving the desired outcome, for that measure.
  4. Divides the number of patients from Step 3 by the total patient population for the top performing clinicians.

CMS is currently evaluating two possible methods for determining the five-star rating:  1) the equal ranges method, which divides the range of performance scores on a given measure into equal-size subranges, and 2) the cluster method, which groups or clusters clinicians into similar performance scores.  According to CMS, both methods would accurately reflect the distribution of performance scores among clinicians.  However, the equal ranges method would provide more stable star-rating cut-offs from year to year, while the cluster method, which is used in other CMS programs, would offer the benefits of consistency and familiarity.  In addition, clinicians and groups within each cluster would tend to have similar performance scores, an advantage that could be helpful to users.

For high performing measures—measures in which almost all clinicians or groups meet or exceed the benchmark—CMS is considering two reporting options: 

Option 1:  Only report five stars for that measure on profile pages.  On the positive side, this option translates into more publicly reported data and star ratings as well as more recognition for clinicians and groups who perform well on the measure.  On the negative side, clinicians and groups who almost meet the benchmark for the measure would not have a star rating.

Option 2:  Do not report any star ratings for that measure on profile pages.  This means that clinicians and groups who nearly meet the benchmark for the measure would not be treated differently than five stars.  The disadvantage is that patients would not be able to see five stars for the measure.

CMS is also weighing the pros and cons of including raw scores, benchmark scores and reporting mechanisms on profile pages along with the five-star ratings.

The best way for anesthesia and chronic pain providers to stay ahead of this rating system is to report quality feedback through a QCDR and manage any outliers identified in the group.  Public consumption of rating information could become very important in future years, not only to patients, but also to hospital administrators.  We continue to recommend that groups remain vigilant in their reporting.

Questions, suggestions and feedback on Physician Compare can be directed to PhysicianCompare@Westat.com.  More information is available at the Physician Compare website.

With best wishes,

Tony Mira
President and CEO