Lack of physician enthusiasm for CMS proposals is nothing new. After electronic reports were made available to 1,600 physicians and medical groups in 2010, fewer than 10% were downloaded, the AMA said, citing a Government Accountability Office report.
Barbara Sack, MHSA, executive director of the Midwest Orthopaedics medical staff in Shawnee Mission, KS, questioned the complexities of the reporting and wondered how CMS can evaluate quality to determine pay scales because of so many differences in an individual service line, with many subspecialties.
An orthopedics practice reflects many areas where there may seem to be quality differences, but because of variations of patient conditions, not how the work is performed, Sack told CMS in a recent conference call.
For instance, a sports-medicine physician may have lower costs because he sees "sports-minded people" as opposed to a foot and ankle surgeon who sees "patients who have uncontrolled diabetes" that may "cost more, but it's not due to his treatment," according to Sack. "It is due to the uncontrolled diabetes."
So the physician quality reports may differ dramatically without a true reflection of the quality of the doctor's work, she suggested.
"I'm trying to figure out how you're determining quality if you are basing it on these (reports)," she told CMS. Officials there acknowledge that they are still sorting out the role of subspecialties, but they believe a "tiered" structure would be implemented to take into account such quality differences among patient conditions.
Still, the data processing questions remain. CMS insists it is taking steps to engage physicians, but many docs aren't buying the CMS outreach, or are simply finding the process confusing. Part of it is CMS's fault; another part, the physicians.
Obviously, "we're probably not where we want to be. We are just at the beginning of a sea change how we interact with providers," Brennan said. The government seeks "to harness the data to actual points of care," he said.
Sometimes, government feels caught in the middle, but certainly docs feel the same way about the data collection process. "You're damned if you do and damned if you don't," Brennan said.