"We're moving toward a point at which there's an expectation that a certain level of quality will be delivered, and that date is 2015," says Bruce Bagley, MD, interim president and CEO of TransforMED, a subsidiary of the American Academy of Family Physicians, which supports physicians in their development of medical homes. "And they'll be using 2013 calendar year (performance) data… with the level of payment moving up or down, depending on the data."
Look for scoring of group practice data to be posted on Physician Compare as well, starting next year.
No longer will doctors have to simply check a box that they prescribed the drug they thought the patient needed or any of CMS's recommended process measures on the expanding federal list.
The time is coming soon when they'll have to show their patients improved, or didn't get worse, at least by some defined measures, if they want to receive their full Medicare reimbursement.
For example, instead of being scored on the basis of whether they ordered periodic hemoglobin A1c testing for all their patients with diabetes, doctors' quality of care might be gauged on what a percentage of patients with unfavorable A1c levels met a certain A1c threshold after treatment.
That's tough; we all know. Doctors can tell patients to lose weight or take their medication or exercise, but the advice often falls on deaf ears.
The PQRS program began in 2007 as a voluntary pay-for-reporting initiative, in which doctors received a 2% bonus for reporting on fewer than 70 process measures. Few participated at first.