Those using paper medical records found they had to build redundancies into their practice. Some indicators only had to be addressed yearly. However, there was often no easy way to confirm completion. This meant that physicians conforming to PQRI’s requirements had to go over indicators each time a patient was seen to ensure they were covered at least once.
Report Structure Concerns
The structure of the reports also proved to be problematic. “One indicator was whether a patient with osteoporosis had had a DEXA test recently,” says Karen Kolba, MD, a rheumatologist in solo practice in Santa Maria, Calif. “Instead of just yes or no, there were a number of modifiers. To accurately answer the question, we had to track down whether the patient had a bone density study elsewhere and confirm the results.”
Even those practices with computerized medical records found integrating the requirements of reporting with their particular program challenging. The frustration level for many practices increased after the first year of reporting ended on December 31, 2007. Payments were delayed until the second half of 2008. Many physicians not only did not get their payment, but also were unable to find out why. For others, bonus checks were far smaller than anticipated. The MGMA report found that as of August 2008, 29.6% of those responding say they did not know if their practice had earned a bonus. An additional 8.6% had been turned down.
Dr. Flood says he was in the dark on his bonus for several months. Then, a check appeared from CMS with no explanation of what it was for. It took more time to confirm the money was due to him before cashing the check.
“I did not get the bonus, and to this day, I don’t know why,” says Dr. Kolba. “Despite the best efforts of several employees, including my information technology expert, I just wasn’t able to penetrate the Web site and finally gave up.” She wasn’t alone, according to MGMA. Approximately one in four respondents (28.8%) had attempted to access the report and gave up due to difficulties. Around 70% rated accessing the feedback report as extremely or considerably difficult.
Even those able to fight through the Web site protections to get to the data were still left in the dark. “Once you got the data, it was hard to figure out your deficiencies,” says Dr. Baraf. “There was no way to go back and look at the paperwork to see if you were having problems with coding, linking a measure to a diagnosis, or other areas. Typically you get information from CMS on denied claims, but this was totally opaque.”