May 25, 2007

CARDIN INTRODUCES VOLUNTARY MEDICARE QUALITY REPORTING LEGISLATION

Bipartisan measure will allow time for development of clinically valid, evidence-based standards

Susan Sullam: 410-962-4478


WASHINGTON - U.S. Senator Benjamin L. Cardin, D-MD, today introduced legislation to create an appropriate framework for quality measure reporting for Medicare providers. Sen. Cardin was joined by Sen. Arlen Specter (R-PA) as an original cosponsor of the bill.

The Voluntary Medicare Quality Reporting Act of 2007 would require the Centers for Medicare and Medicaid Services (CMS) to follow a deliberative process to develop a new, voluntary quality reporting program that would be phased in over several years.

Last year, Congress prevented a scheduled across-the-board cut of 5.1 percent in Medicare physician reimbursement rates, and froze payment levels. Congress also established the Physician Quality Reporting Initiative program (PQRI), which would make providers eligible for a one-time bonus payment of 1.5 percent of total allowed Medicare charges if they report on certain quality measures starting in July 2007.

This new system, known as "pay-for-reporting," is based on the concept that physicians should receive an increase in Medicare reimbursement only if they participate in extensive quality reporting to the Department of Health and Human Services. Under current law, a permanent quality reporting system is to go into effect in January 2008, after a six-month transitional period.

"Everyone wants the best possible care for Medicare beneficiaries, but I am very concerned about moving forward with standards that have not been adequately tested," said Senator Cardin, who has led efforts to repeal the current flawed physician reimbursement formula, known as SGR. "We must have the right process in place for defining quality measures, and a good system needs sufficient time to assess its appropriateness and effectiveness."

The legislation has been endorsed by the National Medical Association and the Alliance of Specialty Medicine, a coalition of 11 medical specialty societies representing nearly 200,000 physicians.

The Cardin-Specter bill would establish a more realistic timeline for quality measure reporting by health professionals. It would accomplish this by:

  • requiring the HHS Secretary to evaluate the 6-month transitional reporting system and reporting findings to the Congress by June 1, 2008;
  • requiring the Secretary to undertake demonstrations for defining appropriate mechanisms whereby health professionals may provide data on quality measures to the Secretary through an appropriate medical registry;
  • allowing physicians and other eligible professionals to continue reporting to the Secretary quality measures developed for 2007, in order for the Secretary to refine systems for reporting quality measures;
  • after completion of the evaluation, phasing in a permanent Voluntary Medicare Quality Reporting Program, with implementation beginning January 1, 2010, based on a consistent set of rules that define an orderly and transparent process of quality measure development;
  • requiring that the Physician Consortium for Performance Improvement of the American Medical Association be the beginning point for the designation of clinical areas where quality measures are needed;
  • having the Consortium, in collaboration with physician specialty organizations and other eligible professional organizations, develop and propose quality measures to a consensus organization (such as the National Quality Forum) for endorsement; and
  • prohibiting the Secretary from using any measures that have not been recommended by the Consortium and endorsed by the consensus organization.
Senator Cardin also added that "quality measures should be tested across a variety of specialties and practice settings before they are included in a reporting system because measures must be clinically valid to be relevant for defining quality."