Quality


The American College of Osteopathic Surgeons represents your voice in the national surgical quality improvement agenda. We support the principles of surgical patient quality measurement across settings, disseminate tools for quality improvement, develop and advocate for measures that accurately classify surgical care to improve patient outcomes, and promote the use of high-quality clinical data for quality measurement and reporting.

Through the College’s Quality Initiatives Committee, the College works to assist quality improvement efforts among the surgical specialties and participate effectively as a key stakeholder to many national quality organizations.

EHR


ACOS recently signed on to a letter with other specialty medical societies regarding the impending EHR compliance date.

Browse the links below for additional quality related initiatives.

PQRS

ERx

Physician Quality Reporting System


The Centers for Medicare & Medicaid Services (CMS) has continued the Physician Quality Reporting System (PQRS) since its enactment in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). PQRS was the first CMS national program to link the reporting of quality data to physician payment. There are no longer incentive payments being offered for those eligible professionals who successfully participate and the program has now moved into a penalty-only phase. Regulations for the PQRS program are updated annually in the Medicare Physician Fee Schedule (MPFS) rule. More information is available here.

Value-Based Payment Modifier


The Value-Based Payment Modifier (VM), authorized under the Affordable Care Act, provides either bonus payments, penalties, or no bonus or penalties (neutral adjustment) to a physician’s Medicare fee-for-service payments based on the quality and cost of the care they provide. The Centers for Medicare & Medicaid Services (CMS) began applying the VM to physician groups of 100 or more providers in 2015 based on their performance in calendar year (CY) 2013 and began applying the VM to all physicians in 2017 based on their performance in CY 2015.

To avoid 2018 VM penalties, surgeons must participate in the Physician Quality Reporting System (PQRS) in CY 2016. Lack of successful participation in the PQRS program in CY 2016 will result in a 2 percent PQRS payment penalty and may result in additional penalties up to 4 percent under the VM. New for 2016, CMS will apply a payment adjustment period to nonphysician EPs who are physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs). Nonphysician EPs will be held harmless for a downward payment adjustment.

Quality and Resource Use Reports


2015 marked the first year that the Center for Medicare & Medicaid Services (CMS) will distribute Quality and Resource Use Reports (QRURs) to all solo practitioners and group practices nationwide. In early September, CMS made available these QRURs, which reflect performance on quality and cost measure data collected in 2014. These reports serve as a tool to help solo practitioners and group practices better understand their performance on federal quality and cost metrics, which already impact Medicare payments for select physicians and will impact payments for all physicians starting in 2017.

Purpose


QRURs are confidential feedback reports offered under CMS’ Physician Feedback Program that provide information about the resources used (cost) and the quality of care provided by physicians and group practices to Medicare fee-for-service (FFS) patients. The reports are intended to provide comparative performance data that physicians can use to improve the care provided to Medicare beneficiaries.  
Some of the information in the QRURs is also used by CMS to calculate the Physician Value-Based Payment Modifier (VM). The VM, authorized under the Affordable Care Act, provides either bonus payments, payment penalties, or a neutral adjustment (no bonus or penalty) to a physician’s Medicare payments based on quality and cost performance, compared to their peers.

Note that all physicians and group practices will be subject to the VM in 2017 based on a composite score of metrics they report under the Physician Quality Reporting System (PQRS) in 2015, and multiple other quality and cost metrics that CMS automatically calculates based on claims. In 2017, eligible professionals may be subject to Medicare payment penalties as high as 4% based on quality and cost performance or for failure to satisfy PQRS reporting requirements. Because satisfactory PQRS reporting is a critical component of the VM, it is critical that all surgeons participate in the PQRS in 2015 and beyond.

Additional Resources


View the CMS audio presentation (and accompanying slides) on how to interpret the QRUR, page by page

CMS Help Desk

For issues with obtaining EIDM account and accessing QRURs, call 888-288-8912.

For assistance with interpreting QRURs and requesting an informal review of your data, contact the QRUR Help Desk at 888-734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov.

Physician Compare Website


Developed as part of the Patient Protection and Affordable Care Act (ACA) of 2010 to increase transparency by publicly reporting data on providers, the Centers for Medicare and Medicaid Services (CMS) designed the Physician Compare website to help patients obtain data about Medicare-participating physicians. The website was created to provide information for consumers interested in making informed healthcare decisions. CMS is using a phased-in approach for the physician information that the agency publicly reports on the website. Physician Compare has been through multiple iterations since it launched in 2011.

Surgical Quality Alliance


The American College of Osteopathic Surgeons participates in the Surgical Quality Alliance. The Alliance lead by the American College of Surgeons works to bring surgical specialties and anesthesiology together to define the principles of surgical patient quality measurement and develop awareness among interested parties about issues related to surgical care and quality in all surgical settings. For more information on the Alliance, visit here.