A Diagnostics & Imaging Week

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS; Baltimore) said last week that as part of its overall quality improvement efforts, it is launching the Physician Voluntary Reporting Program (PVRP) as an initial step toward the ultimate goal of “pay-for-performance,” whereby physicians are paid based on the quality of the care they give.

The new program builds on Medicare’s efforts to “substantially improve the health and function of our beneficiaries by preventing chronic disease complications, avoiding preventable hospitalization, and improving the quality of care delivered.”

Under the voluntary reporting program, physicians who choose to participate will help capture data about the quality of care provided to Medicare beneficiaries, in order to identify the most effective ways to use the quality measures in routine practice and to support physicians in their efforts to improve quality of care.

“Medicare’s contracted Quality Improvement Organizations are helping physicians move toward a more dynamic and evolving public reporting and pay-for-performance quality improvement environment,” CMS said.

Voluntary reporting of quality data through the PVRP will begin in January.

“Given the recognized need for evidence-based quality measures to help improve the quality of healthcare services, and the time required to implement processes to obtain and use such measures effectively, a voluntary program can help Medicare and physicians become better positioned to usher in a system that promotes higher quality and rewards better healthcare delivery,” CMS said in a news release.

The agency said that as noted by CMS Administrator Mark McClellan, MD, PhD, in his Sept. 29 testimony on pay for performance before the House Ways and Means Subcommittee on Health, it “believes that an important component of delivery quality care is the ability to measure and evaluate quality.”

To that end, CMS has developed several quality initiatives that provide information on the quality of care across different settings, including hospitals, skilled nursing facilities, home health agencies and dialysis facilities for end-stage renal disease.

The new system will use the existing administrative system for physician claims. CMS said electronic health records (EHRs) will greatly facilitate clinical data reporting and performance improvement in the future, but their adoption is not widespread.

“CMS is working with physicians to achieve the goal of adopting EHRs in their offices, building on reporting based on the pre-existing claims-based system,” CMS said.

Physicians can begin providing information for constructing evidence-based quality measures for the Medicare population through a defined set of Healthcare Common Procedure Coding System (HCPCS) codes, called “G-codes,” which are reported on the pre-existing physician claim form.

CMS said the G-codes are an “interim step” until electronic submission of clinical data through EHRs replaces that process.

CMS will provide feedback to physicians on their level of performance based upon the data submitted through the voluntary effort. That feedback could begin as early as next summer.

In a statement released by the American Medical Association (AMA; Chicago), AMA president J. Edward Hill, MD, said, “Physicians are dedicated to quality improvement – but without action to halt the Medicare physician payment cuts, new physician reporting measures will gain little traction.

“On Jan. 1, physicians face the first of six straight years of steep Medicare payment cuts totaling 26%. The American Medical Association is staunchly committed to helping physicians provide the highest quality care to their patients.”

Among the 36 quality measures that will initially be evaluated are such things as control of high blood pressure in patients aged 18 to 75 with Type 1 or Type 2 diabetes mellitus to more device-oriented procedures as bone mineral density testing and osteoporosis treatment and prevention following osteoporosis-associated, non-traumatic fracture.

In other Washington news:

• At the request of the FDA Transmissible Spongiform Encephalopathies (TSEs) Advisory Committee, Pall (East Hills, New York) presented during a meeting of the panel on Monday the latest research results on its prion technology to remove TSE infectivity from blood.

The Pall Leukotrap Affinity Prion Reduction Filter system is the only CE-marked technology shown to remove prions from red blood cells, the most commonly transfused blood component, the company said.

Samuel Coker, PhD, principal scientist and technical director of Pall Medical, who has been spearheading the research effort, gave the committee a first-hand look at the validation studies on the performance characteristics of the prion reduction technology filter that were used to earn the CE mark in Europe.

He also presented new results on quality control measures for blood banks to use upon implementation of prion reduction as a means to prevent transfusion-transmitted variant Creutzfeldt-Jakob Disease (vCJD).

TSEs, also called prion diseases, are fatal neurodegenerative diseases that include vCJD, the human form of bovine spongiform encephalopathy (BSE), or “mad cow” disease. The presentation, part of the Advisory Committee’s discussion on labeling claims for TSE clearance studies for blood component filters, is a continuation of Pall’s dialogue with U.S. regulatory and health authorities on protecting the blood supply from prions that can cause vCJD.