What the heck is ‘PVRP’?? And why the heck should I care???

thanks for the links to CMS site.

I am sure that this just the latest fade in medicine.  It will eventually become fiscally unaffordable for the healthcare system to tackle this new administrative cost.  All physicians that I know want to practice quality medicine.  If it is proven that these items improve quality, then this information should and will become part of our board certification process.  Under the new standards of maintenance of certification (MOC), a chart review is mandatory.  I recently completed my office record review (ORR), which is performed online with immediate response as to how I was meeting the standards of care.  I even had to pay $750 just to participate in the ORR part of my board (re)certification.  This process was relatively painless since I have an EMR with health maintenance guidelines, forced entry of documentation and the ability to pull records quickly from anywhere.  Once interoperability is achieved, such information can be electronically submitted in real time to the Board/CDC/CMS/FBI/DEA.  

I ask, why does Congress want to pay a paltry amount to check for quality and add significantly to the administrative costs of healthcare when physicians already have methods of performing similar tasks as part of board certification?  It seems like another layer of unnecessary healthcare spending.  Does this render American Board of Medical Specialties useless once a report card is made available to the public concerning this data?    

I should note that even with an EMR, it is likely that submitting this data will be a break even propsition at best.  With paper, this is a loosing proposition.  $40 x 1.5% = $0.60.  A little more than the current cost of postage.  On the other hand if you are going to pay me $650 x 1.5% = $9.75 for antibiotic prophylaxis in surgical patients, then I guess I would race to report this information.  (I'd rather be paid a bonus for going the whole year without a post-operative infection as is takes more than just a simple antibiotic to prevent an infection.)

During my recent interview with Dr. Winn, he mentioned something rather frightening regarding the "grading" of doctors.

Some doctors take the toughest cases. They are going to look bad if you just measure outcomes, because these doctors begin with the sickest patients, then try to keep them alive--and out of the hospital--as long as possible, even though the hope for a positive outcome looks pretty grim.

I think one such doctor is Cyath, who has described some of the most hopeless medical situations I've ever heard about.

In a medical world which is becoming increasingly "goal oriented", are we running the risk of "patient rejection" by doctors who don't want a sick-as-hell patient who will be a "curve wrecker"?

Already, many medical device makers are moving out of the U.S. because of the potential for devastating lawsuits. I would hate a system that makes the best and bravest doctors look bad because they tackle the toughest medical problems, whereas a doctor who only treats mild colds looks lke a miracle worker.

In a medical world, which is becoming increasingly "goal oriented", are we running the risk of "patient rejection" by doctors

Low reimbursements have already brought this about.  The question is whether this will exacerbate an increasing trend to treat only those cases that make economic sense.

Low reimbursements?  Where do ya'll live? Our's just goes up.  Actually, diabetes with renal manifestation (250.40) describes  the sicker diabetic (than just 250.00) and the payor systems capture this and pay us more for the "curve wreckers."

Oh, and here's link:

http://www.cms.hhs.gov/PVRP/

 "Third, to make reporting as straightforward as possible, the PVRP uses G codes (and when they are available, CPT II codes) on the claim form to pass data to CMS."

Here in Indiana, many practices no longer accept Medicaid patients.  (Same rate schedule since 1996)  This is a form of rejecting patients.  In addition, physicians who choose to see Medicare patients who have Medicaid must accept 20% less than the Medicare rate schedule for full payment.  There is one thing that I learned in all my years of practice and that is that you can’t practice good medicine if you are poor.

I'm not against anything the will bring reimbursements up to a level that matches the service provided, and I accept the fact that physicians will likely never receive 100% of every dollar that they are worth, but it is undeniable that low reimbursements already restricts access and thus we are seeing a decrease in the health of our population.

I actually must commend Congress in attempting to increase reimbursement for physicians in an indirect manner.  PVRP might be acceptable to their constituents who would otherwise be against seeing this group of individuals receiving a pay raise.

@Contrarian: From everything I've read so far, the cost of reporting may well outweigh any increase in reimbursement. Medicaid is a broken, broken system, and our practice cannot survive on their 'payment' system. We have been forced to cap new primary Medicaid patients, yet do not turn away those with Medicare as primary despite the loss. I actually spoke to the director of Medicaid in my state regarding their huge (six figure) debt to us in unpaid claims. He asked accusingly how I got his number, sent out some minion to hear us out, and they never paid anything. Tax payer fraud through and through. Their agency was 200m in the hole that year, too.

On topic:

For Ophthalmology, I can only see "Antibiotic prophylaxis in surgical patients" as a consistant measure, with some cases of checking HgA1C and BP for diabetics, and a few fall related injuries. Anyone care to comment? (I am not a doctor) Do we have to report 'not eligible' for every other exam, or cases where the PCP has those conditions in good control?

The surgery part seems doable w/o EMR.

OK, after taking a closer look at this PVRP it hardly seems worth it.  For primary care, Docs must answer (up to) 7 questions for every pt using 28 new G-codes as answers which are then submitted with the claim.  The typical 99213 allowed is $55.97 times 1.5% bonus equals 84 cents. ??

The problem with the PVRP (one of many) for EMR users is that you would have to add all of the G codes to your billing software, write logic in your EMR to translate the quality measure or exclusions into the appropriate G code and then have it transfer to your billing software. Thats a lot of work for a few cents when you can easily report the quality data directly from your EMR. They decided to use this program as there are a minority of physicians using EMRs and CMS if not ready to receieve quality data directly where they are already set up to receive billing codes. They do have a pilot for EHR users with financial rewards ~15K per provider max or $150K per practice max) but only in California, Utah, Arkansas, and Massachusetts, only in practices with 10 or fewer physicians and if that is not restrictive enough, the practice had to already have signed up with their state QIO for the DOQIT project.