An Invitation to Participate
The Centers for Medicare and Medicaid Services
The Physician Voluntary Reporting Program
Susan Nedza MD, MBA, FACEP
There is much agreement among stakeholders about the need to transform the healthcare system and the imperative to build an efficient healthcare system that provides high quality care. The same stakeholders recognize that our current system is unsustainable in part due to a reimbursement model that rewards quantity of care and not quality. The pressure of ever increasing costs in the system are driving Congress, CMS, employers and private payers to look at payment mechanisms that reward high quality, efficient care. This includes rewarding healthcare professionals and systems of health care delivery that provide value and healthy outcomes for patients. The expectation is to promulgate programs that seek to align reporting and payment structures with the physician professional goals of providing high quality care. The Physician Voluntary Reporting Program (PVRP) is a first step in that process.
The CMS quality vision is of a system that rewards the right care for every person every time. Care should be safe, effective, efficient, patient-centered, timely and equitable. The PVRP has been designed to allow physicians to document when they provide high quality care that meets these goals. This vision crosses all boundaries where patients receive care including hospitals, home, nursing homes and in the outpatient setting.
Why emergency medicine?
CMS recognizes that emergency departments play an important role on the interface between all of these areas. It is at the confluence of outpatient and inpatient care, between chronic care and acute care, and between primary care and specialists. To date, initiatives such as the Hospital Quality Alliance and projects such as the Premier Demonstration Project have begun to capture hospital level data that reflects the quality of emergency care through a data abstraction process. The PVRP will capture the component of care at the level of the emergency physician and do it through the Part B claims process.
Why should you commit to participate?
CMS is actively encouraging emergency physicians and their groups to commit to participating in this program. There are a number of reasons why you should strongly consider doing so. These include:
*It is an opportunity to assess your performance based on nationally established clinical measures and identify gaps in care. In the hospital quality reporting initiative, those organizations that participated early benefited from learning about their performance prior to having payments attached to such a reporting program.
*As Congress contemplates revising the SGR (the formula that determines the physician fee schedule update), physicians should recognize that there is interest in incorporating pay for reporting programs in any future revision of the SGR.
*To make this as straight forward as possible and to provide flexibility, you can utilize either G-codes or CPT category II codes that can be pre-listed on a worksheet to capture and submit this information for each eligible patient encounter. The PVRP provides you the opportunity to utilize CPT II code modifiers to report specific patient exclusions based upon medical judgment, patient factors, or health care system circumstances that may impact physician choice of therapies.
*Participation at this point will allow you to ensure that your medical records, office software and claims processing/billing system vendor can support the submission of this information to CMS now and in the future.
*Finally, your participation in PVRP now will give you the opportunity to provide CMS with valuable feedback on what works and what needs improvement in the program.
What is being measured in the program?
The program includes an initial core set of 16 evidence-based quality measures that are clinically valid and linked to quality of care outcomes. PVRP measures were established nationally through a collaborative process across medical specialties. It is intended that the core set of measures will expand to include additional clinical conditions. The two measures initially being targeted for Emergency Medicine include:
*ASA at arrival [in the emergency department] for acute myocardial infarction
*Beta-blocker at time of arrival [in the emergency department] for acute myocardial infarction
For a complete list of all 16 core measures, their specifications, and more information, please go to
For a sample worksheet for emergency medicine, please go to
Information on CPT category II codes is also available on the Web. Please go to http://www.ama-assn.org/ama/pub/category/10616.html
How do you participate?
You can register your intent to submit data now. Simply go to http://www.qualitynet.org/pvrpintent and register. You can register individuals or groups on the site.
You can then begin to submit data. Sample worksheets to facilitate capturing data are available on the PVRP Web site. These can provide a method for capturing the physician action that can then be coded and submitted to CMS through normal billing mechanisms. Instructions for this process can also be found on the Web site.
The sooner you begin submitting data during the Second Quarter of 2006, between April 1st and June 30th, the more feedback on the measures you will receive in December. This data will be contained in a confidential provider feedback report. The results can then be incorporated into your own quality improvement activities.
CMS Next Steps
Over the next few months, CMS will continue to build upon our quality measurement activities and increase the number of specialties addressed by further expanding the measure set. Efforts will be made to allow this process to be part of our ongoing activities to move toward electronic healthcare records. CMS will also be evaluating the value of the provider feedback report.
The PVRP provides an opportunity for ED groups to begin to provide their own data on physician level performance that does not rely on the hospital's quality abstraction process. As many are aware, the hospital data quality system may not capture the physician action, the physician thought process, or capture the coding necessary to give credit to emergency physicians for the quality of care that they provide.
Many thanks to all of you who are committed to providing quality care to every patient that you care for 24/7. If you have any questions about the program or other aspects of the CMS quality agenda, please feel free to contact me at:
Physician Participation Invitation
MLM Matters 5036