Mass Noncompliance with MOC; Already There with MOC:PQRS?

OK, I’m getting to this issue way late, but I’m trying to find out what my responsibility is regarding the Maintenance of Certification: Physician Quality Reporting System or MOC:PQRS. Here is my message to the Centers for Medicare and Medicaid Services (CMS), the American Board of Medical Specialties (ABMS), the American Board of Psychiatry and Neurology (ABPN), my department, the Iowa Medical Society (IMS), the Iowa Psychiatric Society (IPS), and the Iowa Board of Medicine (IBM).

“I’m a Clinical Track Professor in the Psychiatry Department at The University of Iowa Hospitals and Clinics in Iowa City, Iowa. I’m enrolled in the 10-yr Maintenance of Certification (MOC), though I’ll be moved into the Continuous MOC program after this April, assuming I pass my Psychosomatic Medicine board exam.

I’ve been trying to get information from those within my department about what my responsibility is for participating in the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) as it relates to Maintenance of Certification (MOC).

Evidently there could be penalties in the form of reduced payments from Medicare for diplomates. CMS lists the American Board of Psychiatry and Neurology (ABPN) as participating in the PQRS reporting structure, http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Qualified_2013_MOC_Posting_Doc_05-28-2013.pdf

The role of ABPN is outlined in the following document, at link http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/MOC_2014_Qualification_Requirements.pdf

CMS, in conjunction with the Affordable Care Act (ACA) law, created the PQRI (now called PQRS) financial incentives to physicians who participate in Maintenance of Certification (MOC). In connection with that, beginning in 2014, “physicians who do not submit measures to PQRI will have their Medicare payments reduced.” This is taken directly from a condensed version of the ACA, http://www.dpc.senate.gov/healthreformbill/healthbill53.pdf. It’s on page 23 of the pdf document under TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE: Subtitle A—Transforming the Health Care Delivery System: Part I – Linking Payment to Quality Outcomes under the Medicare Program, Sec. 3002. In it’s entirety:

“Improvements to the physician quality reporting initiative. Extends through 2014 payments under the PQRI program, which provide incentives to physicians who report quality data to Medicare. Creates appeals and feedback processes for participating professionals in PQRI. Establishes a participation pathway for physicians completing a qualified Maintenance of Certification program with their specialty board of medicine. Beginning in 2014, physicians who do not submit measures to PQRI will have their Medicare payments reduced. Section 10327 provides an additional 0.5 percent Medicare payment bonus to physicians who successfully report quality measures to CMS via the new Maintenance of Certification program and eliminates the MA Regional Plan Stabilization Fund.”

One CMS document says I don’t need to sign up for PQRS,http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/

However, the same document also says that in order to be eligible for the incentive payment, I have to report on some kind of quality measures. I’m assuming I also have to act somehow in order to avoid penalties as well, as CMS says:

“Beginning in 2015, the program also applies a payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS.”

I hope somebody can help me with the questions below:

1. My problem is that I’m not sure exactly what I’m supposed to do to avoid penalties. The CMS slide set at link http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/JuneNPC_061813_v061713.pdf starting on slide 22 supposedly tells me how to avoid the payment adjustment. I’m wondering about slide 27, where it says the downward adjustment doesn’t apply to accountable care organizations (ACOs). As far as I know I’m employed within an ACO. Does that mean I’m exempt from the penalty?

2 Beginning on slide 29 (how to avoid the penalty in 2015) in the link in the immediately preceding paragraph, what measures am I supposed to be reporting? If I don’t have to register in the first place, why should I have to do this?

3. I didn’t participate in 2013 CMS-calculated administrative claims-based reporting mechanism because I was not aware of the program. No one in my department, the hospital, the college of medicine, or at the ABPN informed me about the PQRS, much less how the MOC interfaces with that program. How can I be penalized?

4. Is the ABPN sending data to CMS on my participation in MOC?

I have all I can do to keep up with my clinical and academic responsibilities as well as comply with the MOC reporting structure for just keeping my specialty board certification current and attempting to accommodate the principle of lifelong learning to the MOC framework. I think the PQRS interface with MOC is unnecessarily confusing. I think it’s also unfair because many physicians are probably not aware of this PQRS mechanism, which has a “carrot-and-stick” feel to it.”

My commitment to patient care, education, and my support of evidence-based practice are what have sustained me in the last 17 years in my career as a psychiatrist. The MOC in its current form, especially when coupled with a complicated process like the PQRS, fails to support my goal of continuous improvement and actually undermines it.”

How many other psychiatrists knew about this and, if they did, how they find out? So far, the ABPN has sort of tried to help me. They have sent helpful links:

http://www.abpn.com/downloads/moc/MOC_Template_letter_diplomates_MOCMatters.pdf

http://www.abpn.com/forms.html#moc

http://www.abpn.com/downloads/moc/MOC_PQRSFacts_and_FAQs_updated07312013.pdf

Until today, I had no idea these links existed. In fact, at first I thought the “MOCMatters” link belonged to the ABPN. It’s actually a part of the ABMS web site. I’m still waiting to hear from the ABMS, CMS, and my department. It’s possible that I wouldn’t be responsible for participating in the MOC:PQRS because we’re part of an ACO or because of the payment structure between University of Iowa Physicians (UIP) and CMS.

But I’m still not clear on this. I can imagine this might have a serious impact on the income of office-based psychiatrists–unless they’re not accepting private insurance, Medicare or Medicaid. That may be the case.

One thing I know. If those of us who are opposed to MOC believe that mass noncompliance with MOC is the way to go–we’re probably already doing it.

Let me know what your experience has been with the MOC:PQRS–if you know.

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Comments

  1. I should clarify how I meant “mass noncompliance.” When I used that term, I was trying to shed light on the irony of it in the context of our opposition to MOC and MOL. I had no intention of suggesting that physicians caught in the mire of MOC actually put their credentials, hospital privileges, livelihoods and families in jeopardy by mass noncompliance with an idiotic process perpetrated by bureaucrats.

    I meant to show that doctors can’t help but be “noncompliant” with a process that CMS, ABMS, and other large, faceless corporations with no conscience perpetrate deviously on doctors, sneaking abominations like the MOC:PQRS past us without properly notifying us about it in what I believe is a cynical effort to demoralize us with a mindlessly Kafkaesque process.

    I don’t think reactions like mass noncompliance will help physicians. I think they’ll hurt us. I did not use “mass noncompliance” literally. We’re noncompliant because CMS, far from “bombarding” us with information about how to be successful participating in MOC, failed to prepare us for the byzantine circus of MOC:PQRS.

    We’re “noncompliant” because ABMS and CMS kept doctors in the dark about the facts of the MOC:PQRS as well as the true impact and implications of it.

    We’re “noncompliant” not by our choice, but by their design.
    What I’m doing is exposing this travesty to my state medical and psychiatric societies as well as my state medical board.

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