Medicare Adds Measures to Voluntary Reporting Program


Medicare officials plan to expand their voluntary quality reporting program to include more subspecialty measures next year.

The Physician Voluntary Reporting Program was launched last January with a set of 16 core measures, representing 19 of the 39 Medicare physician specialty designations. For 2007, Medicare officials have developed a draft list that includes quality measures that cover 32 of the 39 medical specialties.

Officials at the Centers for Medicare and Medicaid Services recently released a list of 86 unique quality measures from which they plan to select a subset for use in the program. The final list is expected to be posted by Jan. 1, 2007, but the list may be updated throughout the coming year. At press time, the list included 21 measures for internal medicine and family medicine, 11 for geriatrics, 8 for cardiology, 9 for neurology, 1 for psychiatry, 3 for rheumatology, and 4 specific to endocrinology.

Under the program, physicians can use either G-codes or CPT Category II codes, when available, to report on the measures. Physicians who participated in 2006 can expect to receive confidential feedback reports from the CMS sometime this winter.

In assembling the draft list of measures for 2007, CMS officials gave preference to measures that had been adopted or endorsed by the AQA (formerly called the Ambulatory Care Quality Alliance) and the National Quality Forum (NQF). They also tried to first include measures for which electronic data collection could be used, instead of reporting on claims.

But some physician groups have cited concerns about the additional measures being considered by the CMS. Dr. Lynne M. Kirk, president of the American College of Physicians, said that some of the 86 measures listed by the CMS have not been fully vetted by either the AQA or the NQF.

But Dr. Kirk is hopeful that the CMS will listen to the group's concerns. Last year, CMS officials had proposed beginning the program with 36 measures, but after hearing feedback from medical specialty societies, pared that list to a starter set of 16 measures.

While the intent of the program is good and the measures have been well chosen, the program creates too large a burden on physicians, said Dr. Richard Hellman, president-elect of the American Association of Clinical Endocrinologists.The use of G-codes to report data means that physicians have to train their staff to use the codes, he said. And even physicians who have already adopted electronic health records don't have a clear path to submit data electronically. While the CMS allows the use of CPT-II codes, which can be transmitted electronically and more easily by paper, these codes are not available for all measures. The CMS should only use measures that have CPT-II codes available, Dr. Hellman said.

The other major issue is that physicians are not getting any additional money for participating in the program, Dr. Hellman said. Physicians take on additional costs to report the data and they should be given an incentive, he said.The American College of Cardiology does not have a formal position on the Physician Voluntary Reporting Program. ACC officials were involved in the development of the eight cardiology-specific measures that are being considered for inclusion by CMS and ACC supports their inclusion in the program. But more details are needed on what data collection methods physicians can use. “We feel that payment for quality or performance is a complex issue and more testing and evaluation of the measures and prospective data collection tools” are needed, according to an ACC statement.

Of the eight measures for cardiology, five were for treatment for coronary artery disease. They included the percentage of CAD patients with diabetes and/or left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or angiotensin receptor blocker (ARB) therapy, and the percentage of CAD patients who received antiplatelet therapy, at least one lipid profile or all component tests, and β-blocker therapy for prior MI.

The other three cardiology measures were for heart failure, and included the percentage of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitors, ARB therapy, and β-blocker therapy; and the percentage of heart failure patients with paroxysmal or chronic atrial fibrillation prescribed warfarin therapy.

Information on the Physician Voluntary Reporting Program and the draft list of quality measures is available online at

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