Medical Billing Outsourcing Companies

Healthcare Reform

One of the major problems raised by healthcare reform in the past decades is the administrative burden it places on physicians. One Weill Cornell Medical College and Medical Group Management Association (MGMA) survey recently asked doctors at 394 practices across the nation and found the following things.

  • On average a physician spends 2.6 hours every week on quality reporting alone.
  • With staff time included, the time spent on quality reporting is 15.1 hours a week, which is 785.2 hours a year.
  • The annual cost of quality reporting comes to around $40,000 per physician.

One of the goals of the healthcare reform is to drive value, which is to get the maximum quality care delivered to patients at the lowest possible cost, but this effort gets sidelined when practices are forced to spend so much on CMS compliance. Luckily, there is a more user-friendly means to getting this done, such as through the use of Qualified Clinical Data Registries (QCDRs), which also significantly reduces the cost of quality reporting.

Since the year 2007, CMs has been offering incentives for quality reporting by individual providers and group practices, with the current version of the program including the Physician Quality Reporting System (PQRS) and Value Modifier (VM). According to the latter,

  • An eligible provider must report at least 9 CMs approved quality measures which cover three national quality strategy domains.
  • Based on the mechanism employed for reporting, provider should also report on outcome and cross-cutting.
  • In order to get a “satisfactory” grade, reporting should cover at least half of the patients for each reported measure.
    Medical Billing Healthpac

    Quality Reporting

  • Individual providers who fail to successfully report will receive a 2 percent negative payment adjustment to Medicare reimbursement.
  • Provider groups that don’t report successfully based on Tax ID will get a negative payment adjustment to the tune of 4 percent.

The benefits of QCDRs

  • Using one allows the provider access to considerable amounts of data which can aid care decisions as well as improve outcomes.
  • Physicians get to review and compare their own performance, as well as gain access to best practices and improvement tools.
  • Providers and practices can report data on non-PQRS measures, and CMS-approved specialty measures. This allows them to report on what is most relevant to their practice.

According to many experts, CMS is likely positioning the QCDR to become the preferred reporting mechanism, although few of them have been approved at this time.