Healthcare purchasers speaking at the summit stressed that quality measures in medicine are part of a larger movement toward transparency, so that a purchaser can better evaluate what he or she is buying. “We’re trying to transform Medicare from a passive payer to an active purchaser of high-quality, efficient healthcare,” said Thomas B. Valuck, MD, JD, director of the Special Program Office for Value-Based Purchasing at CMS. Dr. Valuck cited CMS’s Physician Quality Reporting Initiative (PQRI), a new, voluntary Medicare program that offers a potential bonus of 1.5% for reporting on quality measures. (See “Medicare Quality Movement Reaches Clinicians,” June TR, p. 1, for more on PQRI.) “Pay-for-reporting is the first step toward P4P,” said Dr. Valuck.
Dr. Valuck noted that the Medicare Payment Advisory Commission (MEDPAC), which reports to Congress, supports the concept of value-based purchasing, and has developed principles to guide the design of a P4P program and select the quality measures that would support it. MEDPAC favors rewarding healthcare providers with financial bonuses, and has recommended that 1% to 2% of Medicare outlays be set aside for these financial rewards.
Dr. Valuck favors the utilization of quality measures that have been submitted by a physician specialty group, and also favors working through the consensus model. As did other speakers at the summit, Dr. Valuck said the electronic health record (EHR) should make the reporting of quality data feasible. “We’re moving from a claims-based to a more clinically based reporting system,” he said. “We need to take a long-term view of what we’re going to be accomplishing and not get discouraged. It’s not going to be perfect coming out of the gate.”
This perspective is important, he said, because the PQRI incentive bonus is too small to make much of a difference in the short-term. “I think the incentive amount didn’t really excite most folks,” said Dr. Valuck. “There’s just one pot of money. What I would encourage you to do is think of this as quality improvement. In the near future, the bonus won’t be a major driver. Over time we might be able to allocate more to the quality-improvement pool.”
We want to make sure that what we do is practice friendly. The goal is to integrate quality measures into recertification programs.
Insurer Perspective
Transparency of data is “very big in the health insurance industry right now,” said Catherine MacLean, MD, PhD, medical director of WellPoint, Inc., in Thousand Oaks, Calif. “Quality of data broadens the dialogue beyond fees to building a foundation of trust,” she added. WellPoint has P4P measures, but does not yet have ones for rheumatologic diseases. “Our P4P programs use nationally endorsed, standardized measures wherever possible. Performance measures should be robust, especially for specialty care,” she said. Asked by Dr. Solomon why rheumatology quality measures are not on the WellPoint list, Dr. MacLean said insurers would like to have quality and transparency data on all physicians, and rheumatology hasn’t yet been a priority.
