Quality of Care on Display

 In Articles, Policy Updates, PQRS

A few weeks ago I was helping my 24-year-old son understand the insurance benefits that comes with his new job and a recent Explanation of Benefits (EOB). His response: “That’s crazy! You’re saying when I go to the doctor, I don’t know how much it is going to cost until I get the bill?” His next question: “How come there are so few doctors on Yelp? If I have to go to an in-network doctor, how do I choose?” Welcome to the 21st century and the mindset of the next generation!

As we head into 2016, medical practices are focused on Medicare Quality Programs in order to complete their reporting for 2015 and avoid payment cuts in 2017 and maybe even earn some incentive bonuses. We are scrambling to document that we reached the 10% threshold or performed the appropriate quality activity on at least one patient, so we can check off the box. But by focusing on the requirements, we are missing the value.

Your future patients will be looking for you online, and they will find you. They will find the performance scores that you have reported to CMS through the PQRS program, and they will see star ratings that show how your score stacks up to the national mean. The Physician Compare Website is active now – here’s a snapshot of what you can see at https://www.medicare.gov/physiciancompare/.

Physician Compare

Currently, the website includes 2014 data for 14 selected PQRS measures. All providers who reported PQRS as a group in this reporting year and selected any of these measures are included.  Providers who reported individually on claims have data for up to six measures; and providers in larger groups over 100 providers also have CAHPS patient satisfaction data reported. By the end of 2016, all providers reporting PQRS for the 2015 reporting year will have their quality scores published on this website in a similar fashion.

I frequently hear the argument: “But I have a large senior population, and they don’t use the internet much.” It’s a comforting fallacy. Your established patients may not look at your profile, but new patients, and the sons and daughters of seniors, will increasingly be looking for information around healthcare services just as they do for restaurants and handymen.

It’s time to take quality measurement seriously. Make it a priority in 2016 to get your providers involved and make a strategic plan around quality. Instead of focusing on the burden of reporting quality measures to CMS and the potential pay cuts, focus on selecting quality measures that are meaningful to your patients and to your providers. Get the whole staff engaged in developing the tools and processes that will allow you to excel at your selected measures. Monitor results regularly and share with your providers and staff. Publicize your successes by posting them on your own website or in your practice.

MSOC Health is here to help. Our consultants have real-world experience in practice operations and process improvement, combined with detailed knowledge of payer requirements and initiatives. Contact Jeanne Chamberlin at 919-442-2422 or j.chamberlin@msochealth.com.

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