Pathologists’ Participation and Performance in the Medicare Physician Quality Reporting System

Objectives Public reporting of quality metrics has become increasingly important for pathologists to demonstrate excellence of care and to secure value-based payments from both public and private payers. This study evaluated the participation and performance of pathologists in the Medicare Physician Quality Reporting System (PQRS). Methods This study conducted a retrospective review of the Physician Compare data files from 2016. Specifically, pathologists enrolled in the Physician Compare Initiative were identified and merged with quality data using uniquely assigned National Provider Identifiers. Descriptive statistics and multiple logistic regression were performed using Stata (version 12.1) statistical software (StataCorp, College Station, TX). Results Among the 11,637 pathologists identified in the Physician Compare Initiative, 8,408 pathologists (73.3%) participated in the PQRS. Regression analysis indicated that female gender, foreign medical graduate (FMG), and a larger number of employees in the affiliated organization were associated with a lower likelihood of participating in the PQRS. To protect patient privacy, the Centers for Medicare and Medicaid Services (CMS) only released the quality metrics of 353 pathologists, which were computed based on 20 or more Medicare beneficiaries. The three most commonly reported quality metrics included PQRS#249 Barrett’s Esophagus, PQRS#395 Lung Cancer Reporting (Biopsy/Cytology Specimens), and PQRS#397 Melanoma Reporting. The mean performance rates for the three most common metrics were 98.8% (SD 8.3%), 96.8% (SD 11.9%), and 97.4% (SD 6.9%), respectively. Conclusion A majority of pathologists participated in the Medicare PQRS program in 2016. The performance rates of public available quality metrics remained at high levels with significant variations in some metrics. Future research should examine the quality performance of pathologists as they transition from the PQRS to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program.

Challenges of diagnostic concordance of lung cancer cases in Qualified Clinical Data Registry (QCDR) measure collection by CMS in calculating MACRA's rewards and penalties.

6604 Background: QCDR was introduced for the Physician Quality Reporting System (PQRS) beginning in 2014. A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients. Those who satisfactorily participate in PQRS through a QCDR may avoid the 2018 negative payment adjustment -2.0% of total Medicare payments. PQRS #396 is an example of a measurement by which oncologists may be evaluated. A physician’s QCDR score is determined by his/her numerator and denominator per patient based on total data submitted by various healthcare providers. Methods: IRB approval was obtained for a retrospective review of 60 randomly selected NSCLC pathology reports that were diagnosed at UTMB. The Denominator was determined by CMS to be: The patients were between the ages of 18-75; the diagnosis of NSCLC was coded by the appropriate ICD and CPT codes. The Numerator was determined by CMS to be: Pathology reports with a diagnosis that included pT pN for NSCLC with histologic type vs those not documented for medical reasons vs those specimens that were not of lung origin, or were classified as NSCLC-NOS. Results: The study consisted of 60 NSCLC pathology reports of which 2 were determined in retrospect not to have been lung cancer cases. Another 10 were considered to be incomplete. A final 2 were diagnosed as a different histological lung cancer type. As [60 - (2+10+2)]/60 = 76.67%, adherence to the quality standard was less than perfect even though excellent medical care was delivered. This score puts the institution at risk of a 2% Medicare Payment Reduction in 2018 if a majority of other institutions score even slightly higher. Conclusions: Physician remuneration will be reduced by current information submitted to CMS. As the quality scores will be made public, reputations may be negatively impacted. Coding and billing operations may be hindered in their attempt to accurately submit data to CMS. Healthcare Systems may be less inclined to request outside consults (including NGS) that may provide a different diagnosis that could confuse the QCDR.

Article Commentary: Explaining the Shift to Value-Based Reimbursement in the Setting of Dermatology and Psoriasis

The Department of Health and Human Services has announced a campaign for transitioning Medicare reimbursement from volume to value. A budget-neutral Value-Based Payment Modifier has been implemented that provides for differential payment to physicians based upon the quality of care delivered. The value modifier will be based partially on physician participation in the Physician Quality Reporting System (PQRS), which allows for reporting of information on quality of care to Medicare. The information reported includes both medical data and patient-reported experiences with health care providers. Starting in 2017, the value modifier payment adjustment will apply to all physicians who make Medicare part B fee-for-service charge claims. Physicians who do not participate in the PQRS and satisfy reporting requirements may be assessed negative adjustments to their payments. Dermatologists in particular will be impacted by these changes, as skin diseases, especially psoriasis, account for a significant economic burden in the U.S.