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BLOG: Is there something rotten in the state of Denmark?
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As an early adapter to the world of electronic medical records, my practice is well versed in using the CPT II codes for performance measurement.
These codes are part of the Physician Quality Reporting System (PQRS) and were initially part of a bonus system that paid above the traditional Medicare fee schedule. We learned to use this system in the early days but were not too upset when we did not get a bonus. We have since fine-tuned the process and use the auto alert system on our EHR combined with a final check in the billing department to be sure that our compliance for these codes is close to 100%.
I was shocked this week when I got a letter from CMS that stated I have not met the measure for physician quality reporting. This will mean 2% reductions in my Medicare billings. I noted that my other associates got the same letter. I did some sleuthing among my fellow optometrists, most of whom are also well versed in the PQRS system, and found that many of them also did not meet the measure and they, likewise, were also subject to the 2% reduction. My thoughts turned to one of my favorite Shakespeare quotes on political corruption from the play, Hamlet: “Something is rotten in the state of Denmark!”
Just when I was beginning to believe that this was an optometry problem, I got an e-mail from one of my former students who is a retinal surgeon in Boston and a gifted writer. He sent me his recent op ed piece in KevinMD.com. This piece, “The costly Medicare boondoggle that’s wasting tax dollars and infuriating doctors,” speaks to the fact that the poorly run PQRS program that seems to unfairly shortchange optometrists also shortchanges ophthalmologists. Dr. Lam goes on to point out the shortcomings of the PQRS program that was dreamed up by bureaucrats in search of quality medical care with little understanding of basic medical care let alone unique elements of quality eye care.
Last year, I penned the joyful end of the PQRS program and highly advised my readers to use the CMS public comment period to voice our concerns about the old program and to assist in the implementation of replacement legislation, Medicare Access and CHIP Reauthorization Act (MACRA). If any of you took the time to officially comment on this Act, your messages went unheeded. As Dr. Lam so eloquently points out, “Medicare will be doubling down on this [PQRS] strategy and rolling it into a new program called MIPS: Merit-based Incentive Payment System. But changing the name won’t make it any more effective.”
In my first blog of last month, I posed the question, “Who is driving the boat?” Here I pointed out that a significant number of global health care items were adversely affecting our ability to provide quality health care. The PQRS and MIPS programs are yet two more examples of how when health care is designed by administrators that do not provide health care, the end result is often the opposite of the intentions.
Doctors in general and optometrists in particular need to get more involved in health care policy and administration as well as the issues of health care reform. Optometrists can get involved with the local optometry society, the state association or the American Optometric Association. These organizations have knowledgeable and informed staff that can help, but they don’t practice optometry and need the input from practicing doctors. Managed care organizations also have advisory boards and committees that need practicing providers to better design their programs.
Health care reform is going to change the way we practice and the way we our compensated for what we do. The change will only be logical and effective if we, as the provider community, get involved and move the reform in the right direction. Without us, something will really be rotten in the state of Denmark.
Reference:
Lam A. The costly Medicare boondoggle that’s wasting tax dollars and infuriating doctors. KevinMD.com. http://www.kevinmd.com/blog/2016/11/costly-medicare-boondoggle-thats-wasting-tax-dollars-infuriating-doctors.html.