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Medicare Pay-For-Performance: 2007 Physician Voluntary Reporting Program

March 13, 2007

In an effort to push pay-for-performance and health care quality data collection initiatives, President Bush signed into law Public Law 109-432 on December 20, 2006, which includes a financial bonus incentive for the 2007 Physician Voluntary Reporting Program (PVRP). One year ago, in January 2006, the Centers for Medicare and Medicaid Services (CMS) launched the PVRP to help capture data about the quality of care provided to Medicare beneficiaries. Physicians who registered to report to CMS 16 various quality measures, such as whether a patient received aspirin shortly after arrival in the emergency department or whether adult patients diagnosed with major depression were documented as treated with antidepressants, were eligible to receive confidential feedback in December 2006 on their reporting rate and performance rate for each measure reported. However, there were no financial incentives to report the measures, until now.

Physician 2007 Bonus Payments
Beginning July 1 through December 31, 2007, physicians who participate in the PVRP can qualify for a 1.5% bonus payment. The list of quality measures available for reporting has increased from 16 to 66 and the number of applicable measures will vary by physician specialty. (The new law also requires CMS to propose quality measures for 2008 that have been adopted or endorsed by a consensus organization, such as the National Quality Forum. CMS must publish these measures in final form by November 15, 2007.)

To be eligible for the bonus payment, physicians who have three or fewer quality measures applicable to their practice must report on those measures in at least 80% of the cases in which the measures apply. For physicians who have four or more applicable measures, physicians must report on at least three of the measures in at least 80% of the cases in which the measures apply.

CMS Procedures for Bonus Payments
CMS has tried to facilitate participation in the PVRP by creating worksheets that physicians can fill out and give to billing personnel to assist in submitting the correct codes with the physician’s Medicare claim submission. These worksheets, as well as additional information about the PVRP, can be found at http://www.cms.hhs.gov/PVRP/. Unless the 110th Congress amends the PVRP again, the financial bonus is only temporary and does not apply to the quality measures that physicians can report beginning in 2008. So physicians wishing to take advantage of the bonus payment should register their intent to participate through the secured link, http://www.qualitynet.org.

If you would like more information on the PVRP initiative or any related questions, please contact Barbara Zabawa (608-284-2639 or bzabawa@gklaw.com) or another member of our Godfrey & Kahn Healthcare Team.

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