Monday Musings

Are you thinking that PQRS is only for practitioners? More and more hospitals are on the hook to get PQRS right. This year, the Physician Quality Reporting System payment “adjustments” officially move from the incentive to the penalty phase.  I’ve talked a lot about what this means to providers. However, many hospitals are now affected because they are acquiring doctor’s practices. This is a challenge for hospitals because they’ve been focused on inpatient quality measures and they are not familiar with the measures that individual practitioners are reporting. Furthermore, providers have used a variety of ways to report measures (e.g. from claims to various EHRs). To manage physician quality, hospitals need to repurpose their quality committees to include both inpatient and outpatient metrics.

What I worry about is that the hospitals will try to get all the physicians reporting big vanilla measures that end up being meaningless. What do orthopedics and cardiology have in common from a quality standpoint? They can report medication reconciliation and BMI measurement, but there are no measures of the quality of CARE these specialists provide which will work for both specialties. A hospital is NOT going to find a “unification theory” quality measure that ties together all specialists under one amazing “Great Measure of the Universe.” That’s the reason there are hundreds of quality measures and there was still a need for Qualified Clinical Data Registries (QCDRs) to develop measures for areas like wound care that didn’t have any.

9-14-15Head’s up hospital—you will need a lot of specialty measures and some of them will be QCDR measures. Tell your EHR vendor to get on board.