AAOS Bulletin - February, 2006

CMS introduces Physician Voluntary Reporting Program

Orthopaedic measures included in core starter set

By Robert H. Haralson III, MD, MBA

This year, for the first time, the Centers for Medicare & Medicaid Services (CMS) will be collecting data from physicians on a wide range of clinical measures. Although the program is now voluntary, it may become mandatory as part of the move toward pay-for-performance.

According to CMS, the primary purpose of the Physician Voluntary Reporting Program (PVRP) is to provide a means for physicians to report clinical data using the claims process. This clinical and other claims data can be used to calculate quality measures. Physicians who participate will receive confidential feedback, if requested, on their reporting and performance rates.

Originally, CMS had selected 36 sets of G codes for the program. But after much discussion with physician organizations, including the AAOS, the CMS decided to adopt a smaller core starter set to lessen the potential reporting burden on physicians and better align the PVRP program with other quality measurement activities.

The core set of 16 standards (see box) includes measures that apply to a variety of physician specialties. Primary care measures are based on those endorsed by the National Quality Forum and are part of the Ambulatory Care Quality Alliance starter set. The confidential reports available to physicians will be limited to the 16 core starter standards. The CMS hopes that this will encourage physicians to report clinical data on a high percentage of patients for whom measures are applicable.

Additional details on the program can be found online.

Robert H. Haralson III, MD, MBA, is AAOS executive director of medical affairs. He can be reached at haralson@aaos.org

PVRP core starter standards

(Standards with an orthopaedic impact are in boldface type.)

• Aspirin at arrival for acute myocardial infarction (AMI)

• Beta-blocker at time of arrival for AMI

• Hemoglobin A1c control in patients with Type I or Type II diabetes mellitus

• Low-density lipoprotein control in patients with Type I or Type II diabetes mellitus

• High blood pressure control in patients with Type I or Type II diabetes mellitus

• Angiotensin converting enzyme inhibitor or angiotensin receptor blocker therapy for left ventricular systolic dysfunction

• Beta-blocker therapy for patients with prior myocardial infarction

• Assessment of elderly patients for falls

• Dialysis dose in end-stage renal disease patients

• Hematocrit level in end-stage renal disease patients

• Receipt of autogenous arteriovenous fistula in end-stage renal disease patients requiring hemodialysis

• Antidepressant medication during acute phase for patients diagnosed with new episode of
major depression

• Antibiotic prophylaxis in surgical patients

• Thromboembolism prophylaxis in surgical patients

• Use of internal mammary artery in coronary artery bypass graft surgery

Preoperative beta-blocker for patients with isolated coronary artery bypass graft

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