Presentation at the International Symposium on Osteoporisis 2009
PHYSICIAN KNOWLEGE AND OPINION OF THE CMS’S PHYSICIAN QUALITY REPORTING INITIATIVES (PQRI) AS THEY RELATE TO OSTEOPOROSIS
Matthew J. DiPaola M.D., Satya Patel M.D., Judith Spahr MLS, MEd, CCRP, CTR
Thomas Jefferson University, Lankenau Institute for Medical Research
Background: The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries. This system was implemented by the Centers for Medicare and Medicaid Services (CMS) in July 2007 on a voluntary basis and under the title of the Physician Quality Reporting Initiative (PQRI). It is a pay-for-performance program which creates incentives for physicians to adopt best practice guidelines for over 100 known clinical practices. Five of these practices relate to the recognition and treatment of osteoporosis. We hypothesized that most physicians in a position to treat patients with osteoporosis are either unaware or ill quipped to implement them into practice.
Methods: We created a 13 question survey to gauge physician practice patterns, awareness of PQRI initiatives as they relate to osteoporosis and opinions regarding ideal osteoporosis referral and treatment.
Results: 238 surveys were sent and 74 were completed for a response rate of 31%.
61% of responders treat musculoskeletal conditions almost exclusively. Nearly half of responders state that 21-40% of there patients are covered by Medicare and another 30% state that 41-60% are covered by Medicare. 73% stated that they were either “slightly familiar” or “not familiar at all” with PQRI guidelines. 64% and 68% respectively stated that they “did not know” how many initiatives applied to their practice or how many they adhered to currently. 60% sited increased time, manpower and paperwork as potential barriers to implementing these guidelines. Responses were mixed regarding which physician should be responsible for managing osteoporosis with answers favoring family care and rehabilitation specialists. Most agreed that orthopedic surgeons should initiate communication after fragility fracture to the primary care physician. And 97% felt that a medical physician such as family practitioner, endocrinologist or internist should manage bisphosphonate therapy, not a surgeon. Opinions were nearly evenly split regarding whether the 1.5 % bonus was satisfactory or not to induce a change in behavior in physicians.
Conclusions: This survey study highlights a relative lack of awareness, significant perception of barriers to implementation and ambivalence regarding effectiveness of the PQRI incentive program as it pertains to osteoporosis performance improvement measures. Significant hurdles remain if such initiatives are to achieve the intended purpose of better standardized care and cost reduction. And it is unclear whether the program in its current state is sufficient to accomplish these goals.
