Medicare's low-quality program

Medicare's system to report physician quality is burdensome to physicians and fails to promote better care. It must be scrapped.

Editorial. Dec. 5, 2005.

Medicare's soon-to-be-launched Physician Voluntary Reporting Program is expected to be the first step in creating a systemwide pay-for-performance program focused on quality improvement. But it's fitting that the word quality isn't in the name, because it appears the program's ability to promote better care is highly questionable.

Though Medicare as yet has no broad pay-for-performance program, the PVRP allows physicians who choose to participate to submit quality information on Medicare claims and receive feedback on their performances.

Physician participation in PVRP is not linked to Medicare reimbursement. The program begins on Jan. 1, 2006, and expects to start reporting performance results to physicians by that summer.

The problem is, Medicare's program falls short on credible quality standards and is long on onerous administrative burdens.

On Nov. 3, the American Medical Association sent a letter to Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, expressing its "strong objection" to the PVRP. The letter, signed by the AMA Board of Trustees, outlined several major problems with the program.

It details the ways in which CMS, despite the AMA engaging it in a variety of settings on how to most accurately measure performance, used little of that input in constructing the PVRP. "In the PVRP, CMS has bypassed a significant body of collaborative work in favor of its own reporting program," the board wrote in its letter.