More from January 2014 - Vol. 33 No.01
As the new year begins, it is important for members to stay abreast of the various upcoming quality initiative deadlines. In an effort to provide clarity and highlight valuable resources, the Academy encourages members to utilize the Centers for Medicare & Medicaid (CMS) eHealth Programs Timeline, which can be found at http://www.cms.gov/eHealth/downloads/Timeline_091213_FINAL.pdf. The interactive timeline not only emphasizes looming deadlines, but also provides explanatory steps to ensure compliance with new and ongoing initiatives.
Key 2013 Dates
2013 proved a critical year for physicians participating in various quality initiatives. Important dates and deadlines included:
October 1—Start of the EHR Meaningful Use (MS), Stage 2 reporting period for eligible hospitals and Critical Access Hospitals (CAHs) for the 2014 fiscal year.
October 15—Last day for groups to register for participation in Group Practice Reporting Option (GPRO) for the 2013 Physician Quality Reporting System (PQRS) program year via Web Interface or registry reporting.
October 15—Last day for individuals and groups participating in GPRO to submit administrative claims-based reporting to avoid penalties in 2015.
October 15—Last day for groups of 100 or more Eligible Professionals (EPs) to self-nominate/elect quality-tiering for Value Based Payment Modifier.
November 30—Last day for Medicare eligible hospitals and CAHs to register for the Medicare EHR Incentive Program for 2013.
November 30—Last day for Medicare eligible hospitals and CAHs to register and attest to receive an incentive payment and for eligible hospitals to submit their 2013 fiscal year data through QualityNet to receive an incentive payment.
December 31—Reporting PQRS for 2013 for both group practices (participating in GPRO) and individual EPs ended.
December 31—Reporting for 2013 Electronic Prescribing (eRx) incentive for group practices (participating in GPRO) and individual EPs ended.
What to Expect in 2014
So what’s in store for 2014? 2014 will be as pivotal as 2013 regarding quality initiative rollout dates. Members should be aware that February 28, 2014, is the last day for EPs to register and attest to receive an incentive payment for 2013. Additionally, February 28 is also the last day to submit PQRS data through some reporting methods (Registry and EHR direct submission). February 28 is also the last day to submit Clinical Quality Measures (CQMs) for the EHR Incentive Program Electronic Reporting Pilot. Lastly, the deadline to complete your practice’s transition to ICD-10 is October 1, 2014.
Academy Resources
In addition to CMS’s interactive timeline, the Academy has numerous resources available to members, including:
PQRSwizard: PQRSwizard is a CMS-certified registry product tailored for otolaryngologists. This online tool helps collect and report quality measure data for the PQRS incentive payment program. Access the tool at https://aaohns.pqrswizard.com/ and http://entnet.org/PQRS.
ICD-10 ENT Superbill: The ICD-10 ENT Superbill is designed to assist members in quickly completing and submitting procedure(s) and diagnosis(s) codes from a patient visit for reimbursement. A sample for members can be found at http://bit.ly/entICD10.
Quality Program Initiative Fact Sheets: The Academy has developed three quality program initiative fact sheets that provide an overview of each quality initiative (PQRS, EHR, and eRx). Access the fact sheets at www.entnet.org/cmspenalties.
These materials and resources are designed to aid in member participation in the initiatives. The Academy understands that the breadth of reporting requirements imposed on physicians can be daunting. Please feel free to email us for support or to suggest additional resources that would be helpful at healthpolicy@entnet.org or quality@entnet.org. Rahul K. Shah, MD
George Washington University School of Medicine;
Children’s National Medical Center, Washington, DC
We are all familiar with the Institute of Medicine’s landmark clarion call to improve the safety and quality of care delivery in the United States healthcare system. This report, released almost 15 years ago, served as a catalyst for the modern patient safety and quality improvement efforts and successes.
As the last decade and a half has progressed, the role of the consumer (i.e., patient) of healthcare has emerged. The power of the consumer in the healthcare transaction has grown tremendously. Hospitals actively compete for patients to provide care for some services that have high margins and are lucrative for the hospital.
How do the hospitals compete for these patients? Of course they must all have excellent outcomes. For example, perhaps a couple of decades prior, we would have been able to compare three hospitals and see disparate results in terms of outcomes—i.e., one would be at 30 percent, another at 50 percent, and the best at 80 percent. Metrics at present are so narrowly defined and the quality of care has improved so significantly that when comparing institutions and providers, quality scores are within a range of a few single digits; for example, these three institutions may now score 98.7 percent, 98.9 percent, and 90.9 percent. What do these numbers mean for the consumer? How is the consumer going to be able to choose where to take their care? They are probably not going to base their decision on these outcome or quality metrics.
Satisfaction Surveys
Enter the patient satisfaction movement/craze to which physicians are beginning to have to pay attention. There are myriad healthcare satisfaction and experience surveys. These are nothing new; however, they were not widely popular until the past couple of years. Indeed, some otolaryngology practices are piloting the HCAHPS (hospital consumer assessment of healthcare providers and systems) survey for their outpatient practices. These surveys are a “measure” of the “experience” of the consumer. There is variability in such patient satisfaction and experience metrics that perhaps the consumer will be able to discern and select the best institution from these measures.
Providers continue to be squeezed in a schizophrenic environment where there are competing demands, unfunded mandates, and outright financial deductions for not adhering to or meeting certain metrics. As I often say, I could easily have the highest patient satisfaction scores in the hospital: I would only see one patient every week. Of course, this extreme is not sustainable on many levels.
I have been fortunate to have spent time with and heard a few talks from James Merlino, MD, the chief experience officer of the Office of Patient Experience at the Cleveland Clinic, when he discussed the intersection of patient safety, quality improvement, and patient satisfaction. He has come up with an excellent example of how they intertwine. He uses the airline industry as an example and paints the following story: our first priority when choosing an airline is to ensure we get to where we need to be safely, without crashing (patient safety); once we understand that we are safe, we then want to ensure that we arrive on time and leave on time within reason (quality); once this is established, only then do we consider the inflight amenities and overall comfort (patient satisfaction). Dr. Merlino’s analogy captures eloquently how we should think about patient safety, quality, and patient satisfaction in healthcare delivery.
As there will inevitably be many competing priorities and many ideas du jour, it is imperative that Academy members have the ability to rise above the fray and see the proverbial forest for the trees. The analogy further helps us understand the intersection between patient safety/quality improvement and patient satisfaction by prioritizing each one and putting them in a linear perspective. The connectedness is much tighter than we appreciate at first glance, and the relationship is perhaps also much more symbiotic than we appreciate.
The study of patient satisfaction is an emerging frontier in the care delivery cycle and one that Academy members need to be versed in. Our own Academy member, Emily F. Boss, MD, MPH, has published several peer-reviewed articles on this topic and explains in her excellent articles the relationship between patient satisfaction, disparities in care, and improvement opportunities. Suffice it to say, the next couple of years will be interesting as providers learn how to navigate these intersecting priorities.
We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice. At last year’s AAO-HNSF Annual Meeting & OTO EXPO℠, the new Resident and Fellow-in-Training Involvement Campaign was introduced as a means to increase participation from these groups in advocacy-related initiatives. It is essential for residents and fellows-in-training as the future of the specialty to learn about the Academy’s advocacy efforts and become involved early in their careers. The campaign, which is a competition among otolaryngology residency programs, provides AAO-HNS residents and fellows-in-training the opportunity to earn points for themselves and their residency programs.
With the start of a new year, now is the perfect time to have your residency program become fully involved with this new campaign! Participation is easy, and in some instances, it only takes a minute to join this ongoing effort. Take part in these small activities and earn points for yourself and your program.
Join the ENT Advocacy Network and earn one point.
Follow @AAOHNSGovtAffrs on Twitter, friend us on Facebook, and connect on LinkedIn to earn a total of three points.
Donate to ENT PAC and gain five points.*
These points also come with great rewards. For example, participants in the program receive an exclusive Advocacy Investor T-shirt by earning seven points. The training programs that receive 100 percent participation receive a special breakroom treat. The program with the most points overall will be rewarded with an exclusive networking event with top Academy members at the next annual meeting.
Who will be the top advocacy training program in 2014? Only time—and advocacy involvement—will tell! For more information on how to earn more points and increase your training program’s ranking in this fun challenge, email govtaffairs@entnet.org.
*Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.
State Legislatures Back in SessionAs we celebrate the new year, many state legislatures across the nation are convening their legislative sessions. AAO-HNS “state trackers” should watch for legislative reports in their email. Reports are sent daily, but will include updates only on bills that are newly introduced, amended, scheduled for a hearing, or receiving a floor vote. If you are concerned you may not be receiving reports, please email govtaffairs@entnet.org.
State trackers should also prepare for our next legislative conference call on January 22. The goals of the conference call series are to help educate state trackers, provide a forum to identify national trends, and receive input on the specific needs of each state. The calls last about one hour and will be limited to participants in the state tracking program and state society staff. Trackers will receive an email with the time and login information for the conference call.
Thank you to all AAO-HNS members who have already volunteered to fill this important role! If you are interested in becoming a state tracker in your state, please email govtaffairs@entnet.org. It’s that time of year again—a time for fresh starts and new perspectives, right? If only that thought rang true for Congress. As the second session of the 113th Congress convenes this month, we find that not much has changed and the ideological divide that paralyzed the nation’s capital for several weeks last October is still alive.
This month, Congress would have faced the first of two critical deadlines put in place by the “compromise” that ended last fall’s government shutdown. Congressional leaders had set a January 15 deadline to develop a framework for funding the government. However, in mid-December, U.S. Representative Paul Ryan (R-WI) and U.S. Senator Patty Murry (D-WA) announced that a two-year budget deal had been reached. Included as an amendment to this bill was language to halt (for three months) the 20+ percent cut in Medicare physician payments scheduled for January 1, 2014. Instead, physicians will receive a .5 percent positive increase during that time. This payment “bridge” is intended to avoid payment disruptions as Congress completes its work on permanent SGR repeal legislation early next year. The budget compromise, including the SGR “bridge,” was passed (332-94) by the U.S. House of Representatives on December 12, and, at the writing of this article, the U.S. Senate was scheduled to consider the legislation sometime during the week of December 16.
Looking to next month, Congress will again contend with increasing the nation’s borrowing capacity, with the February 7 deadline capping what could well become an extremely contentious start to the year. Several key issues—including changes to entitlement programs, and tax reform—remain focal points for the negotiations. In addition, implementation of the Affordable Care Act and general healthcare reform efforts will likely also remain recurring themes as Congressional leaders again attempt to find common ground regarding the aforementioned issues.
The ease—or pain—by which these two early deadlines are addressed will undoubtedly be woven into the election-year rhetoric that will begin taking center stage as the primary season for the 2014 mid-term elections gets underway. So, unfortunately, 2014 is poised to be yet another year that lacks substantial legislative activity, with the outcome of this year’s elections largely determining the outlook for Congressional comity versus continued contentiousness through 2016. 
