Final Rule: Public Reporting on Anesthesiologists and Other Physicians
The last two issues of the Alert reviewed changes to the Physician Quality Reporting System (PQRS) and to the Value-Based Payment Modifier (VM) announced in the Final Fee Schedule Rule for 2015. This week we will note for the record some of the most meaningful numbers in the Final Rule—the conversion factors—and explore developments regarding two of CMS’ transparency ventures, the Physician Compare website and the Open Payments program.
Conversion Factors for 2015
The Final Rule announced two different conversion factors (CFs) for each of two different periods: January 1 through March 31, 2015 and April 1st onward. On April 1st, unless Congress enacts yet another fix to the Sustainable Growth Rate (SGR) formula, the delayed 21.2-percent cut will go into effect. The CFs for the two periods are:
The figures for the first three-month period are slightly different from the CFs for 2014 because of required budget neutrality adjustments and changes to practice expense values.
Whether Congress will intervene to block the cuts scheduled for April is an open question, although it has done so every year thus far. At its recent meeting in Dallas, the American Medical Association renewed its call for repeal of the SGR. As its president, Robert Wah, MD, told the AMA House of Delegates: "Last spring we made another run… and achieved what we didn't have before—a framework to end the SGR, with bipartisan and bicameral support, backed by more than 600 physician groups. We're now delivering this message: Congress must eliminate the SGR in the lame duck session. Why? Because it's essential to sustainable practice and preserving access…. It might not happen during this lame duck session, but the end of SGR is not a matter of if, but when."
Physician Compare
Medicare’s Physician Compare website, which was mandated by the Affordable Care Act, was launched in 2010 and redesigned in 2013. It is intended to serve a two-fold purpose: (1) to help consumers make informed healthcare decisions, and (2) to create explicit incentives for physicians to maximize performance. It provides, for all physicians, nurse anesthetists, anesthesiologist assistants and certain other healthcare professionals, information including primary and secondary specialties and board certification status, medical and clinical training, hospital and group practice affiliations, and the status of the provider’s 2012 participation in the Physician Quality Reporting System (PQRS), the Electronic Prescribing (eRx) Incentive Program, and the Electronic Health Record (EHR) Incentive Program. (See Alert What Does Medicare’s Physician Compare Website Say about Anesthesiologists, CRNAs and AAs?, March 3, 2014.)
CMS is now following through on its commitment, made a year ago in the Final Fee Schedule Rule for 2014, to publish performance and not just participation data. The Agency plans to post information on all 2015 PQRS individual measures collected via claims, registry or EHR systems on Physician Compare in late 2016 “if technically feasible.” CMS will also expand public reporting of group-level measures by making all 2015 PQRS Group Practice Reporting Option (GPRO) web interface, registry, and EHR measures for group practices of two or more EPs and all measures reported by ACOs available for public reporting on the website in 2016. According to CMS, “these data must meet the minimum sample size of 20 patients and prove to be statistically valid, reliable, comparable, and accurate.” In general, no first year measures will be publicly reported on Physician Compare.
Physician Compare will also publicly report on whether the EP successfully participated in the Medicare EHR Incentive Program and in the 2014 PQRS Maintenance of Certification Incentive. This is the last year of the eRx Incentive Program, so there will be no further posting of participation status in that initiative.
CMS had proposed to develop and publish certain composite scores and benchmark data, based upon consumer input, for both individual EPs and for groups. There has clearly not been enough time for the Agency to establish and test composites or benchmarks for purposes of Physician Compare, but the interest is ongoing. CMS announced its intent “to evaluate other programs’ methodologies, including the Value Modifier, to work toward better alignment across programs.” There is no projected date for the future scores and benchmarks.
The AMA, the Medical Group Management Association, the American Society of Anesthesiologists and other organizations had all filed “comment letters” on the Proposed Rule this past summer, describing a high level of errors in the data previously posted and inadequacies in the mechanism for EPs to review their information. ASA, notably, urged CMS to consider doubling the preview period from 30 to 60 days for physicians to examine their quality data before posting. CMS acknowledged the concerns in the Final Rule discussion, but its bottom line is simply “that we will detail the process for the 30-day preview and provide a detailed timeline and instructions for preview in advance of the start of the preview period. … Group practices and EPs with available data for public reporting will be informed via email when the preview period is going to take place. Group practices and EPs will be provided instructions for previewing data and information for on how to request help or have questions answered.” Meanwhile, providers are encouraged “to reach out to the Physician Compare support team at PhysicianCompare@Westat.com for any questions or concerns regarding the information included on the website.”
Open Payments – Physician Financial Transparency Reports
The Physician Payment Sunshine Act, part of the Affordable Care Act, requires manufacturers of drugs, medical devices and biologicals to report certain payments and items of value given to physicians and teaching hospitals.
In the Proposed Rule, CMS had indicated that it would make four changes to the Open Payments program, including the controversial elimination of the provision in the Sunshine Act that exempts from reporting certain compensation to speakers at Continuing Medical Education (CME) programs. Under the provision, applicable manufacturers do not report compensation to a physician for speaking at a CME event as long as the CME program is accredited by one of the five accrediting bodies listed in the Sunshine Act regulations, and the physician is not chosen or directly compensated by the applicable manufacturer.
Physician organizations had urged retention of the provision (42 C.F.R. Section 403.904 (g)(1)) in order to avoid “chilling” physician participation in CME activities, but CMS proceeded with its elimination on the grounds that another statutory exclusion would adequately protect indirect payments to accredited CME speakers when the manufacturers are “unaware of” or “do not know” the identity of the payment recipient during the reporting year or by the third quarter of the following year.
Controversies such as the distinction between the two statutory exclusions—which CMS resolved by declaring that the specific exclusion that was eliminated was never necessary in the first place because the type of payments in question did not meet the criteria for reportable indirect payments—demonstrate just how painfully complex the Open Payments program has become. CMS apparently agreed when it acknowledged “that manufacturers may need additional time to comply with reporting requirements” and scheduled the implementation of the new data collection requirements for January 1, 2016.
Of more immediate impact, reports on 2013 payments from manufacturers were released to the public on September 30, 2014. These reports are available at cms.gov/openpayments. To review your own data, you need to complete the registration process described in our Alert of August 18, 2014 (Physician Payments Sunshine Act: Anesthesiologists Should Register and Review Their Information) if you have not already done so. As an alternative, you might go to OpenPaymentsData.CMS.Gov and see whether there you appear in the database at all before going through the registration steps. You have until December 31st to review and dispute information. CMS will not resolve disputes, but the next release of the data will show which information, if any, is disputed.
We second the AMA’s recommendation that physicians be prepared for inquiries from patients, from the media and even from friends by knowing what is reported about you and being able to place the information in context. The AMA’s Sunshine Act Talking Points can be customized for your circumstances and could be helpful.