your path: Home > Policy >
Why is quality an important area of focus for the Society?
- Current payment systems do not consider quality in determining reimbursement.
- The incentives the current reimbursement systems provide sometimes promote poor quality care.
- The present fee-for-service payment systems pay providers based on the number and complexity of services provided to patients without regard to quality, efficiency, or impact on health outcomes. Pay for performance has been proposed as one strategy for correcting this deficiency.
Back to Top
Are there any programs in place to test Quality Initiatives?
First launched in July 2007, Medicare’s Physician Quality Reporting Initiative (PQRI) provides a financial incentive for providers to participate in voluntary quality reporting. Eligible providers who successfully report self-selected quality measures chosen from the PQRI's designated set of measures on claims for services provided may earn a bonus payment. In 2008, this payment, subject to a cap, equaled as much as 1.5% of total allowed charges for services covered by the Medicare physician fee schedule. (Payments for lab tests and drugs are not included).
Enacted in July 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) (HR 6331) made the PQRI program permanent, but only authorized incentive payments through 2010. Eligible professionals who submit quality measures from January 1, 2009 to December 31, 2009, will earn an incentive payment of 2.0% of their total allowed charges for Physician Fee Schedule covered professional serviced furnished during that same period. The 2009 PQRI consists of 153 quality measures and 7 measure groups. For additional information on the 2009 PQRI quality measures, click here.
For reporting years 2007-2009, the statute has somewhat constrained CMS’ ability to make program adjustments; however, for 2010, the Agency has been granted wider discretion to consider program modifications. MIPPA provided the authority for the Agency to revise reporting periods and criteria in consultation with experts and stakeholders. Therefore, CMS will consider suggestions and recommendations for such changes and will publish any proposals in the Physician Fee Schedule proposed rule for Calendar Year (CY) 2010, which is expected to be issued in June of this year. CMS hopes to obtain valuable feedback from providers and eligible professionals on program elements, including a group practice reporting model, measures groups and individual measures, in addition to issues related to reporting periods and reporting criteria.
Back to Top
What is the Society’s position on Quality?
The American Geriatrics Society (AGS) strongly endorses efforts to ensure that every older person receives high quality, patient-centered healthcare. The AGS strives to create policies and systems that can achieve greater healthcare quality and improved outcomes for older adults, especially vulnerable elders with multiple chronic medical conditions, advanced disease, and dementia. Quality measures for vulnerable older adults and frail elders should be constructed so that multiple chronic illnesses are accounted for and providers are rewarded for treatment that improves quality of life. AGS’ Quality Position Statement was developed to provide policymakers and health plan administrators assistance in moving payment toward a value-based purchasing system in order to achieve greater quality in healthcare outcomes for all older adult patients, including the frail elderly.
Back to Top
|
