Unbiased Analysis of Today's Healthcare Issues

Regulatory Tsunami?

Written By: Jason Shafrin - Oct• 22•14

Medicare is working hard to make sure that doctors are efficiently providing high-quality care. Programs such as the Physician Quality Reporting System (PRQS) and the Value-Based Payment Modifier all are aimed to improve quality and lower cost.

The downside of such programs, however, is that the impose reporting burdens on physicians. For instance, Medicare can adjust a physician’s base payment rate based on:

  • Whether or not they are able to electronically prescribe medication
  • whether or not they fulfill “meaningful use” criteria of electronic medical records
  • the PQRS quality reporting system
  • The value-based payment modifier

Each of these systems overlaps and are phased in over time making it difficult for physicians to track how what their specific payment rate will be.  The AMA states:

The tsunami of rules and policies surrounding the penalties are in a constant state of flux due to scheduled phase-ins and annual changes in regulatory requirements.  In fact, the rules have become so complex that no one, often including the staff in charge of implementing them, can fully understand and interpret them.

In addition, CMS is moving from an ICD-9 system to an ICD-10 coding system, causing the number of codes available to increase from about 13,000 today to about 68,000 codes after the transition.

Payers must balance the desire to monitor provider quality without overburdening physicians with excess regulations and reporting requirements. Finding the correct balance between physicians, CMS’s, and patient desires is a delicate task.

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