Bryan Dowd1, Chia-hsuan Li2, Tami Swenson1, Robert Coulam3, Jesse Levy4. 1. University of Minnesota: Minneapolis, Minnesota. 2. Healthcore, Incorporated: Wilmington, Delaware. 3. Simmons College: Boston, Massachusetts. 4. Independent Consultant.
Abstract
PURPOSE: To explore two issues that are relevant to inclusion of PQRS reporting in a value-based payment system: (1) what are the characteristics of PQRS reports and the providers who file them; and (2) could PQRS provide active attribution information to supplement existing attribution algorithms? DESIGN AND METHODS: Using data from five states for the years 2008 (the first full year of the program) and 2009, we examined the number and type of providers who reported PQRS measures and the types of measures that were reported. We then compared the PQRS reporting provider to the provider who supplied the plurality of the beneficiary's non-hospital evaluation and management (NH-E&M) visits. RESULTS: Although PQRS-reporting providers provide only 17 percent of the beneficiary's NH-E&M visits on average in 2009, the provider who provided the plurality of visits supplied only 50 percent of such visits, on average. IMPLICATIONS: PQRS reporting alone cannot solve the attribution problem that is inherent in traditional fee-for-service Medicare, but as PQRS participation increases, it could help improve both attribution and information regarding the quality of health care services delivered to Medicare beneficiaries.
PURPOSE: To explore two issues that are relevant to inclusion of PQRS reporting in a value-based payment system: (1) what are the characteristics of PQRS reports and the providers who file them; and (2) could PQRS provide active attribution information to supplement existing attribution algorithms? DESIGN AND METHODS: Using data from five states for the years 2008 (the first full year of the program) and 2009, we examined the number and type of providers who reported PQRS measures and the types of measures that were reported. We then compared the PQRS reporting provider to the provider who supplied the plurality of the beneficiary's non-hospital evaluation and management (NH-E&M) visits. RESULTS: Although PQRS-reporting providers provide only 17 percent of the beneficiary's NH-E&M visits on average in 2009, the provider who provided the plurality of visits supplied only 50 percent of such visits, on average. IMPLICATIONS: PQRS reporting alone cannot solve the attribution problem that is inherent in traditional fee-for-service Medicare, but as PQRS participation increases, it could help improve both attribution and information regarding the quality of health care services delivered to Medicare beneficiaries.
Keywords:
Medicare; PQRS; attribution; payment; physician; value
Authors: Rozalina G McCoy; Kari S Bunkers; Priya Ramar; Sarah K Meier; Lorelle L Benetti; Robert E Nesse; James M Naessens Journal: Am J Manag Care Date: 2018-12 Impact factor: 2.229
Authors: Cameron J Gettel; Christopher R Han; Michael A Granovsky; Carl T Berdahl; Keith E Kocher; Abhishek Mehrotra; Jeremiah D Schuur; Amer Z Aldeen; Richard T Griffey; Arjun K Venkatesh Journal: Acad Emerg Med Date: 2021-09-07 Impact factor: 3.451
Authors: Matthew G Mullen; Alex D Michaels; J Hunter Mehaffey; Christopher A Guidry; Florence E Turrentine; Traci L Hedrick; Charles M Friel Journal: JAMA Surg Date: 2017-08-01 Impact factor: 14.766
Authors: Elizabeth Shenkman; Lindsay Thompson; Regina Bussing; Christopher B Forrest; Jennifer Woodard; Yijun Sun; Jasmine Mack; Kamila B Mistry; Matthew J Gurka Journal: Pediatrics Date: 2020-12-01 Impact factor: 7.124
Authors: Jae Gon Lee; Dong Soo Han; Young-Eun Joo; Dae-Seong Myung; Dong Il Park; Seul Ki Kim; Yunho Jung; Won Hyun Lee; Eun Soo Kim; Joon Seok Yoon; Chang Soo Eun Journal: Korean J Intern Med Date: 2020-05-12 Impact factor: 2.884