Payment for Physician’s Services66
The Secretary will monitor changes in the utilization of and access to services furnished under Part B within geographic, population and service-related categories,67 as well as possible sources of inappropriate utilization of services.68 The Secretary will annually report to Congress on changes in the utilization of services, and will include an examination of the factors which may contribute to such changes,69 as well as recommendations addressing any identified patterns of inappropriate utilization. 70
The Secretary will establish a Physician Feedback Program under which the Secretary will use claims data to provide confidential reports to physicians that measure the resources involved in furnishing care to individuals; the Secretary may include information on the quality of care furnished to individuals by the physician in such reports.71 The Secretary will provide reports to physicians that compare patterns of resource use of the individual physician to such patterns of other physicians;72 in preparing such reports, the Secretary will make appropriate adjustments to account for differences in socioeconomic and demographic characteristics, ethnicity, and health status of individuals.73
The Secretary will provide incentive payments to eligible professionals for the adoption and meaningful use of EHR technology.74 An eligible professional will be treated as a meaningful EHR user if the professional demonstrates that such EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination,75 and if the professional submits information using such EHR technology on clinical quality measures.76 The Secretary will post on CMS’ website a list of the eligible professionals who are meaningful EHR users.77
The Secretary will implement a reporting system for eligible professionals78 of data on consensus-based quality measures79 and provide incentive payments for professionals engaging in quality reporting.80 The Secretary will also provide incentive payments to professionals who engage in electronic prescribing.81 The Secretary will post on CMS’ website a list of the names of the eligible professionals who satisfactorily submitted data on quality measures,82 as well as a list of those eligible professionals who are successful electronic prescribers.83
The Secretary will develop a plan by January 1, 2012 to integrate reporting on quality measures with reporting requirements relating to the meaningful use of electronic health records.84 This integration will include the selection of measures, the reporting of which would demonstrate meaningful use of an electronic health record85 and quality of care furnished to an individual.86
The Secretary will establish a payment modifier that provides for differential payment to a physician based upon the quality of care furnished compared to cost.87 Quality of care will be evaluated based on a composite of measures of the quality of care furnished, as established by the Secretary, such as measures that reflect health outcomes.88
Footnotes
- 66. Social Security Act § 1848, 42 U.S.C. 1395w-4.
- 67. Social Security Act § 1848(g)(7)(A)(i), 42 U.S.C. 1395w-4(g)(7)(A)(i).
- 68. Social Security Act § 1848(g)(7)(A)(ii), 42 U.S.C. 1395w-4(g)(7)(A)(ii).
- 69. Social Security Act § 1848(g)(7)(B), 42 U.S.C. 1395w-4(g)(7)(B).
- 70. Social Security Act § 1848(g)(7)(c)(i), 42 U.S.C. 1395w-4(g)(7)(c)(i).
- 71. Social Security Act § 1848(n)(1)(A), 42 U.S.C. 1395w-4(n)(1)(A).
- 72. Social Security Act § 1848(n)(9)(B), 42 U.S.C. 1395w-4(n)(9)(B).
- 73. Social Security Act § 1848(n)(9)(D)(i), 42 U.S.C. 1395w-4(n)(9)(D)(i).
- 74. Social Security Act § 1848(o)(1)(A), 42 U.S.C. 1395w-4(o)(1)(A).
- 75. Social Security Act § 1848(o)(2)(A)(ii), 42 U.S.C. 1395w-4(o)(2)(A)(ii).
- 76. Social Security Act § 1848(o)(2)(A)(iii), 42 U.S.C. 1395w-4(o)(2)(A)(iii).
- 77. Social Security Act § 1848(o)(2)(D), 42 U.S.C. 1395w-4(o)(2)(D).
- 78. Definition of eligible professional. Social Security Act § 1848(k)(3)(B), 42 U.S.C. 1395w-4(k)(3)(B).
- 79. Social Security Act § 1848(k)(1), 42 U.S.C. 1395w-4(k)(1).
- 80. Social Security Act § 1848(m)(1)(A), 42 U.S.C. 1395w-4(m)(1)(A).
- 81. Social Security Act § 1848(m), 42 U.S.C. 1395w-4(m).
- 82. Social Security Act §1848(m)(5)(G)(i), 42 U.S.C. 1395w-4(m)(5)(G)(i).
- 83. Social Security Act §1848(m)(5)(G)(ii), 42 U.S.C. 1395w-4(m)(5)(G)(ii) (See Social Security Act § 1848(m)(3)(B) for standards on a successful electronic prescriber).
- 84. Social Security Act § 1848(m)(7), 42 U.S.C. 1395w-4(m)(7).
- 85. Social Security Act § 1848(m)(7)(A)(i), 42 U.S.C. 1395w-4(m)(7)(A)(i).
- 86. Social Security Act § 1848(m)(7)(A)(ii), 42 U.S.C. 1395w-4(m)(7)(A)(ii).
- 87. Social Security Act § 1848(p)(1), 42 U.S.C. 1395w-4(p)(1).
- 88. Social Security Act § 1848(p)(2)(B)(i), 42 U.S.C. 1395w-4(p)(2)(B)(i).
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