WHAT OTHERS SAY: Doctors must get on board with new quality care standards

Friday, April 20, 2012 | 2:30 p.m. CDT

Last month, 24,000 individual practice physicians in Missouri, Iowa, Kansas and Nebraska were notified that they could get confidential reports on the quality and cost of treatment they provided to Medicare patients in 2010. As of the end of March, only 3,300 of them had bothered to check.

Perhaps the doctors' other responsibilities have kept them from downloading the reports yet. Perhaps they dislike their medical decisions being compared with those of other physicians. Perhaps they believe the project is silly and pointless. Perhaps they're simply apathetic.

Whatever the reasons, the physicians need to get past them and get engaged.

The reports are part of two related initiatives being conducted by the federal Centers for Medicare and Medicaid Services (CMS): the Physician Quality Reporting System and the Physician Feedback/Value-Based Modifier Program. They were authorized by three federal laws signed by President George W. Bush in 2006, 2007 and 2008 and the Patient Protection and Affordable Care Act signed by President Barack Obama in 2010.

The idea, which continues to evolve as CMS accumulates more data and comments from doctors, is that people receive better and more efficient care when their various physicians all know what the rest of them are doing — what tests are being ordered, medications prescribed and diagnoses reached.

Physicians also benefit by seeing how much their approach to treatment costs compared with the approaches of other doctors treating similar patients in the same area.

At present, CMS pays health care providers based on the amount of service delivered to patients. They more services, the more money earned.

But in 2015, the centers will start phasing in a new payment system offering clear financial incentives for demonstrated records of improved quality and cost control in treating Medicare beneficiaries. This major change is scheduled to be complete by 2017.

The quality reports that apparently most doctors in Missouri and the other states haven't bothered to check suggest how the new system will work. Equally important, CMS wants and needs physicians' feedback to improve the new system before it goes nationwide.

What's the point of all this? Virtually everyone agrees that America's health care system costs too much and delivers too little in virtually all objective measures of quality. And, at $2.6 trillion annually — about 17 percent of the nation's gross domestic product — the cost is unsustainable and threatens our long-term economic security.

The CMS programs represent a significant effort to improve care and reduce costs, but they are not alone.

Earlier this month, for example, a foundation associated with the American Board of Internal Medicine collaborated with nine different medical professional groups to launch a new campaign called "Choosing Wisely."

Each of the nine groups released a list called "Five Things Physicians and Patients Should Question." At issue: tests, drugs and therapies with a high likelihood of being unnecessary, ineffective and potentially dangerous in some situations.

One of the participating groups, the American College of Physicians, has gone further by compiling guidelines to help its 132,000 members avoid ordering needless tests that add $200 billion to $250 billion per year to the nation's health care costs.

America's broken health care system is inordinately complex. We are all part of the problem, including the doctors who have failed to review their CMS quality/cost reports. They need to step up and become part of the solution.

Copyright St. Louis Post-Dispatch. Reprinted with permission.

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