Washington Committee: Hot Topics

Special Announcement from the AANS/CNS Washington Committee

June 13, 2007

CMS Launches Physician Quality Reporting Program; Neurosurgeons Must Contact their Senators to Urge them to Co-sponsor Legislation to Modify the Program

The Tax Relief and Health Care Act of 2006 (TRHCA), which halted the 5 percent physician payment cut scheduled for 2007, also authorized the creation of a new program for physician quality reporting, titled the Physician Quality Reporting Program (PQRI). The program will begin in July. Neurosurgeons who participate may earn bonus payments if they meet the program requirements:

Under this voluntary quality reporting initiative, the Centers for Medicare and Medicaid Services (CMS) will provide financial incentives to eligible professionals who successfully report quality information related to services provided under the Medicare Physician Fee Schedule between July 1 and December 31, 2007. Physicians who report on quality measures may be eligible to receive a bonus payment equal to 1.5 percent of all allowed charges for that period, subject to a cap.
To qualify for the bonus, physicians must report on at least three of the program’s 74 quality measures for at least 80 percent of the cases in which the measures apply. A number of measures, including those related to perioperative and stroke care, are applicable to neurosurgery.
There is no special registration process for the 2007 program. Physicians become eligible as soon as they start submitting quality codes with their Medicare claims. To assist CMS with individual-level data analysis, physicians must also include their National Provider Identifier (NPI) on all claims.

Those who successfully report quality data in 2007 will receive a lump-sum bonus payment in 2008, along with a single, confidential performance report.

Should I Participate? Although organized neurosurgery supports efforts to improve quality, the 2007 PQRI will not likely truly improve the quality of neurosurgical care. The measures were hastily-crafted and focus only on processes of care, which do not guarantee improved clinical outcomes and result in little useful quality data. Furthermore, the small financial incentive is unlikely to generate enough money to cover the administrative costs of participating in the program, especially as physician reimbursement continues to decline. On the other hand, the program presents an opportunity for neurosurgeons to gain experience in data collection and quality reporting, to earn a small bonus payment, and to learn about the quality of their care before payment is linked to performance. In deciding whether to participate in the 2007 PQRI, neurosurgeons should therefore carefully weigh these costs and benefits.

Additional Information about the 2007 PQRI Program

For more information on the PQRI, including a list of the 2007 measures and quality codes and instructions on how to test your billing system prior to the program’s start date, please visit the CMS Web site at: http://www.cms.hhs.gov/PQRI/. If you have additional questions about this program, please contact Rachel Groman, AANS/CNS Senior Manager of Quality Improvement and Research, at rgroman@neurosurgery.org or 202/628-2072.

2008 PQRI Program Needs Fixing

Under TRHCA, CMS also has broad authority to implement a permanent quality reporting program in 2008, which is scheduled to begin before the results of the 2007 program are available and could very likely transform into mandatory pay-for-performance. Fortunately, at the request of the AANS, CNS and other specialty societies, on May 24, 2007, the Voluntary Medicare Quality Reporting Act of 2007, S. 1519, was introduced in the U.S. Senate. S. 1519 would amend those provisions of the TRHCA that gives CMS broad authority to expand the program in 2008 with little oversight. The legislation would, among other things, require that the 2007 reporting program be evaluated prior to implementing a permanent program, make clear that the reporting program is voluntary, and defer the implementation date of a permanent program until January 2010.

Whether or not you decide to participate in the 2007 PQRI, it is absolutely critical that you contact your Senators and urge them to cosponsor this very important legislation. Time is of the essence, as CMS is already in the process of developing the 2008 program.

We have made it easy for you to contact your Senators. Please take a minute to do so using the tools below.

By e-mail: Using a special link on the AANS/CNS Legislative Action Center, you can simply enter your zip code and you will be connected to a summary of the legislation and a sample letter that you can edit to tailor to your own personal situation. To connect to the Action Alert and Message, go to: http://capwiz.com/noc/issues/alert/?alertid=9851446.
By phone: A special toll-free number sponsored by the Alliance of Specialty Medicine (of which the AANS and CNS are members) will connect you to your Senators’ offices. Once connected, ask to speak to either your Senator or his or her staff person handling health care issues. The number is 866/899-4088, and the Neurosurgery access code is 9595. After entering the access code you will be prompted to use your telephone keypad to enter your zip code. You will then be connected to your legislators.
By Letter: You may write a personal letter to your Senators. Because time is of the essence, you should fax, rather than mail, your letter. Call their offices for their fax numbers, via the Capitol Switchboard at 202/224-3121.

More details about S. 1519, including a sample letter and talking points, is available at: http://www.aans.org/legislative/aans/quality percent20bill percent20fax percent20alert_060807.pdf.

If you have any questions about S.1519, please contact Lori Shoaf, Senior Manager for Legislative Affairs, AANS/CNS Washington Office at lshoaf@neurosurgery.org or 202/628-2072.