Pay for Performance: Reporting of Quality Metrics in HCV Infection

Practice Watch |
November 17, 2015

Pay for Performance: Reporting of Quality Metrics in HCV Infection

  1. Atif Zaman, MD, MPH

Few clinicians currently report data on HCV measures but will need to start or face reimbursement penalties.

  1. Atif Zaman, MD, MPH

Pay for performance (P4P) has become the cornerstone of how the Centers for Medicare and Medicaid Services (CMS) financially incentivizes high-quality care. All gastroenterologists should know that they will be required to successfully report certain quality measures or be penalized with a reimbursement cut of −2% from Medicare.

In the current review, researchers examined the CMS P4P program in the context of hepatitis C virus (HCV) infection. Highlights include the following:

  • HCV-specific quality measures include testing for genotype and HCV RNA before HCV treatment, testing HCV RNA at weeks 4 and 12 during treatment, hepatitis A vaccination, shared decision-making regarding treatment options, hepatocellular carcinoma screening, medication documentation, and counseling regarding smoking.

  • Research suggests that successful completion of these measures varies widely by measure — between 20% and 80% — and that only about 20% of patients receive all recommended care.

  • Although measures can be reported in multiple ways — via claims data, qualified electronic health record/clinical data registry, or group-practice reporting — HCV quality measures are limited to registry-based reporting because CMS has combined HCV-related measures together as a “measures group.” So, group-practice reporting is not possible.

  • Although performance measures are strongly linked to improvements in performance, their effect on patient outcomes is unclear. Another weakness is that focusing too much on particular process metrics can lead to tunnel vision (looking only at aspects of care related to measures) or gaming (reporting only on patients/outcomes that advertise success).

  • Currently, few clinicians are reporting data on HCV measures.

Comment

Although performance measures have limitations, P4P programs are here to stay; as such, collecting and reporting quality measures will continue to be a critical part of medical practice. Fortunately, there are qualified registries, such as the American Gastroenterology Association Digestive Health Recognition Program, that clinicians can use to help meet the CMS reporting requirements.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

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