We believe that we can fulfill our mission to women’s health only if the issues of practicing ObGyns are addressed in the process. You can’t build a new health care system on a broken medical liability system or a broken Medicare physician payment system, and we still have both. We have a lot more work to do on these issues and the myriad of other issues that need to be addressed. This is really just the beginning of health reform.
9. Has PQRI regained the limelight?
OBG Management: The Medicare quality reporting incentive payments under the Physician Quality Reporting Initiative (PQRI) have been extended. In fact, physicians will be penalized, beginning in 2015, if they do not participate. Are the incentive payments a good thing for ObGyns?
DiVenere: Yes, a big change is coming in this program. ObGyns who participate in PQRI will be eligible to receive bonus payments of 1% in 2011 and 0.5% from 2012 to 2014. Payments will be reduced by 1.5% in 2015 and by 2.0% in 2016 for physicians who don’t participate in the PQRI program.
Beginning in 2012, PQRI participation becomes a meaningful use qualifier for EHR grants.
In 2011 to 2014, physicians who complete Maintenance of Certification (MOC) are eligible for an additional 1% bonus in 2011 and 0.5% bonus in 2012 to 2014. Data on a physician’s quality measures must be submitted on the physician’s behalf by the MOC program. After 2014, the Secretary of HHS can add MOC completion to the quality measures used for the value-based payment modifier. The American Board of Obstetrics and Gynecology hasn’t yet qualified its MOC for this part of the program.
ObGyn participation in the PQRI program is very limited (less than 10%). While only about 25 of the 215 PQRI quality measures apply to ObGyn care, most are easily applicable, and a physician needs to report on only three to five measures to qualify for the program.
The very low participation rate is likely because many ObGyn practices just didn’t think the incentive payment was worth the trouble. They may need to rethink that math once they’re faced with payment cuts in 2015.
ObGyns should also be aware that the Secretary of HHS, with input from stakeholders, will set up a Physician Compare Web site (modeled after the program that already exists for hospitals) using PQRI data. Data will be made public on January 1, 2013, comparing physicians in terms of quality of care and patient experience.
The Secretary must ensure that the data are statistically valid and risk-adjusted. In addition, the physician must be given time to review the information before it becomes public, and data must ensure appropriate attribution of care when multiple physicians and other providers are involved. The Secretary must also give physicians timely performance feedback.
For all these reasons, ACOG is working with the physician community to make a number of improvements to the PQRI program, doing our best to make it as easy as possible for our members to participate and benefit.
10. What effect will the expansion of Medicaid have on ObGyn practice?
DiVenere: Starting in 2014, the same year that state exchanges are expected to be established, Medicaid eligibility will be broadened to cover all individuals younger than 65 years who have incomes up to 133% of the federal poverty level. All newly eligible adults will be guaranteed a benchmark benefit package that provides the essential health benefits.
States that have already expanded eligibility to adults who have incomes up to 100% of the federal poverty level will receive a phased-in increase in the federal medical assistance percentage so that, by 2019, they will receive the same federal financing as other states (93% in 2019 and 90% in 2020 and later). And states have the option to expand Medicaid eligibility to childless adults as of April 1, 2010, but will receive their regular federal medical assistance percentage until 2014.
Although these changes will broaden the range and increase the number of individuals who will be eligible for Medicaid, the effect on ObGyn practice remains to be seen, especially as pregnant women who were covered by Medicaid at income levels above 133% of the federal poverty level transition off of Medicaid and into private health insurance offered in the exchanges.
Today, about 38% of all ObGyns accept Medicaid gynecologic patients, and 44% accept Medicaid obstetric patients. Medicaid accounts for 18% of revenues of the average ObGyn practice.
11. Will the extension of benefits to young adults have a measurable impact on ObGyn practice?