Surgery News - January 2009 - (Page 3) JANUARY 2009 • SURGERY NEWS NEWS Early Experience With PQRI Spurs Improvements for 2009 B Y A L I C I A A U LT Criteria Still Unclear Never Events • from page 1 Else vier Global Medical Ne ws WA S H I N G T O N — Data from the first 6 months of the Physician Quality Reporting Initiative (PQRI) are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council. In the summer of 2008, the CMS paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services. The average payment was $600 for 6 months of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said. There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures. Fifty-two are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups. There will be nine different ways physicians can qualify for the 2% PQRI bonus in 2009, said Dr. Rapp. Physicians also can receive an additional 2% bonus for satisfying requirements under the separate e-prescribing incentive program. Under last year’s Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial. PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, called the idea a “terrifying concept,” as it might appear that physicians who were not on the list did not care about quality. And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted. Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn’t mean that’s the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/ PQRI/Downloads/PQRI2007ReportExperience.pdf ). Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted. There were three major reasons for code nonvalidity: The provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim. Many of the submission errors were for patients who did not meet reporting specifications for gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75 said Dr. Rapp. He said that the CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively. The agency also aims to make some changes that will hopefully reduce the number of rejected reports going forward. The CMS said that it would continue to conduct provider education and outreach to make sure that physicians understand the specifications for reporting each measure. The agency also is working with local Medicare carriers to ensure that when claims get split—where the quality codes are separated—they will be “reconnected and counted,” according to the agency. Also, claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted under the PQRI program were missing an NPI, according to the agency’s report. The CMS expects less than 0.5% of PQRI claims to be without an NPI. ■ appeal the nonpayment. The AMA is still standing by those comments. In its submitted comments, the American Hospital Association also said an appeals process was necessary. Further, it questioned how the wrong-site events will be defined, how accountability would be assigned, and which costs or services would not be covered. The agency also needs to consider scenarios such as a wrong-site surgery that is begun but corrected before there is any harm, said the AHA. The comment period on the CMS proposal ended Jan. 2. There are not a lot of data on the frequency of surgical never events. The CMS cited a 9-year study published in 2006 in Archives of Surgery that reported an incidence of 1 in 112,994 for wrong-site procedures not involving the spine. Several states have recently launched initiatives to track wrong-site surgery. The Pennsylvania Patient Safety Authority found that Pennsylvania facilities reported 286 wrong-site surgeries in 51 months, or 1 every 5.44 days, according to Dr. John Clarke, clinical director of the authority’s reporting system. Pennsylvania facilities must report near-misses and actual incidents to the authority, so this is thought to be a fairly accurate estimate, he said in an interview. Extrapolating the state data gives an estimated four to five wrong-site surgeries each day in the United States, he said. The Pennsylvania data may be viewed on the Web site www.psa.state.pa.us. ■ SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chief, Division of Cardiothoracic Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Gretchen Purcell Jackson, Assistant Professor of Surgery and Biomedical Informatics, Vanderbilt University Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Jay L. Grosfeld, Lafayette Page Professor of Pediatric Surgery and Chairman Emeritus, Indiana University Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Jacob Moalem, M.D., Assistant Professor of Surgery, University of Rochester Surgical Oncology: Patrick McGrath, M.D., FACS, Professor and Chief, Division of General & Vascular Surgery, University of Kentucky Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation, SURGERY NEWS, 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211. SURGERY NEWS (ISSN 1553-6785) is published monthly for the American College of Surgeons by Elsevier Inc., 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960; 973-290-8200; fax 973290-8250. ELSEVIER SOCIETY NEWS GROUP, A DIVISION OF INTERNATIONAL MEDICAL NEWS GROUP President, IMNG Alan J. Imhoff Director, ESNG Mark Branca Executive Director, Editorial Mary Jo M. Dales Executive Editor, IMNG Denise Fulton Executive Editor, EGMN Kathy Scarbeck Publication Editor Elizabeth Wood Publication Associate Editor Jay C. Che http://www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf http://www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf http://www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf http://www.psa.state.pa.us
Table of Contents Feed for the Digital Edition of Surgery News - January 2009 Surgery News - January 2009 Contents The 20/20 Vision Intent to Prevent News From the College: The Year Ahead Thoracic: Tracheal Triumph Practice Trends: Making the Grade Surgery News - January 2009 Surgery News - January 2009 - Contents (Page 1) Surgery News - January 2009 - Contents (Page 2) Surgery News - January 2009 - Contents (Page 3) Surgery News - January 2009 - Contents (Page 4) Surgery News - January 2009 - Contents (Page 5) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 6) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 7) Surgery News - January 2009 - News From the College: The Year Ahead (Page 8) Surgery News - January 2009 - News From the College: The Year Ahead (Page 9) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 10) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 11) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 12) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 13) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 14) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 15) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 16)
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