Obamacare receives a big, fat 'F' from physicians
Many physicians feel that CMS should have waited to launch the site until after all the data is added and has been vetted for accuracy. “Physicians think CMS did not do enough to highlight the disclaimer that this is not comprehensive yet,” De La Torre says.
In addition, many physicians are discouraged by high error rates in accuracy of their members’ information. “The College of American Pathologists had like a 50% error rate for their members,” Shalowitz says. “It might be indicative that the system isn’t what it should be.”
While inaccuracy alone is troubling, it’s made more complex by the fact that physicians will receive a 2% penalty on Medicare/Medicaid payments for not reporting their most up-to-date information to CMS, regardless of whether physicians themselves or a third party sent it. The data submission period closed in November 2015, but penalties are assessed retroactively in two-year increments, so 2016 penalties are based off of 2014 reporting, and so on until and unless new rules are announced.
The American Medical Association and other physicians groups are especially unhappy with the forthcoming fines, De La Torre says. “If the data is incomplete or wrong, they feel it’s unfair.” He predicts that many physicians will challenge those fines in the coming year.
CMS faces a challenge in creating performance standards for the website that are fair and accurate to all physicians across different specialties and sizes of practice. “The data could be timely and accurate, but not meaningful,” Shalowitz says.
He posits a hypothetical situation in which two doctors perform the same procedure, but in different size practices, with different degrees of challenge. The numbers might show a higher morbidity rate for one doctor because he has a smaller practice, or a larger number of sicker patients. “That data is worse than nothing because it would steer people to the wrong place,” Shalowitz says.
Others wonder how likely consumers are even to use the website once it is completed. Shalowitz feels it hasn’t been up long enough, or with sufficiently complete information, for accurate analysis. “In my 15 years of experience, most people don’t make use of objective information in making their healthcare decisions. It’s more often word of mouth,” he says.
While there is some evidence that people pay attention to report cards, De La Torre says, “in general people say healthcare is too complicated, or the quality is not great, but they give their own physicians higher ratings.”
Practices and physicians had a 30-day window to approve their data before it went live on the Physician Compare website, but that review process ended in November, 2015. Physicians who didn’t review their information will see it go live anyway, without an appeals process, according to the CMS website.
For physicians hoping CMS might take down the website due to widespread provider dissatisfaction, De La Torre says that’s unlikely. “CMS is not going to back down,” he says. “This is the path we’re heading down.”
Though a Merritt Hawkins study of 650,000 American physicians found that 85% of physicians have adopted EHRs since 2012, 46% felt that EHRs detract from their patient care. The reporting requirements have proven to be a barrier for many physicians even to obtain the incentives in the first place. Carrie Nixon, JD, says that the most up-to-date numbers, from 2013, show that out of 1.25 million eligible providers, 450,000 did not submit the data to qualify for incentives. That resulted in a loss of 1.5% of the total reimbursement, which she calls “a pretty significant amount.”
“I think most physicians would say that [EHR incentive programs] have had a negative impact because they are having a difficult time getting their arms around the reporting requirements,” she says. “They’ll tell you it’s taking away from time to care for their patients.”