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3 Wound/Ulcer Quality Measures in Physician Compare

Wednesday, December 11, 2019   (0 Comments)
Posted by: Kathleen Schaum
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Reimbursement Reporter

3 Wound/Ulcer Quality Measures in Physician Compare

Kathleen D. Schaum,MS

Information regarding coding, coverage, and payment is provided as a service to the  Academy of Physicians in Wound Healing (APWH) members. Every effort has been made to ensure accuracy. However, APWH and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.

Congratulations on a successful 2019 APWH Annual Conference Scientific Program! This author was honored to be one of the faculty members and appreciated the attendees’ participation in my presentation entitled Volume Based Payment, Value Based Payment - or Bust! During and after the presentation, many attendees asked questions pertaining to the lack of wound/ulcer-related quality measures and to the importance of quality measures in Physician Compare. Due to the huge interest in this topic, following are the frequently asked questions and answers pertaining to this topic.

 

Q:       What is Physician Compare?

A:       The Center for Medicare & Medicaid Services (CMS) posts a searchable database on-line.  It is called Physician Compare and includes profile pages and Quality Payment Program performance information for individual clinicians, groups, and certain Alternative Payment Models (APMs).

 

This information helps patients find and compare clinicians and groups enrolled in the Medicare program. The profile pages list general information about clinicians and groups, like practice locations and phone numbers. The performance information shows the quality of care provided to patients by each clinician and by each group.

 

The Physician Compare information is also reviewed and used by many other stakeholders e.g. health plans when negotiating contracted fee schedules and preferred provider status, merger and acquisition teams, physician and other qualified healthcare professional (QHP) recruiters, and other risk-bearing contracts.

 

Q:       What are the goals for Physician Compare?

A:       The 2 main goals are to:

1.    Encourage patients to make informed physician/QHP choices based on quality performance

2.    Incentivize physicians/QHPs to participate in quality programs and to provide high quality care

 

Q:       Where can I find the Physician Compare database?

A:        https://www.medicare.gov/physiciancompare/search.html

 

Q:       Does Physician Compare list all the quality measures that I report?

A:       No, the CMS decides which measures to report based on the federal rule-making process and published reporting standards. In addition, the CMS conducts consumer testing to determine if consumers understand what the quality measure means and if the information will help them select a physician/QHP.

 

Q:       As a wound/ulcer management specialist, I have a hard time finding quality measures that pertain to my work. You mentioned there is are 2 registries that contain wound/ulcer specific measures. Will you tell me about them and where I can find them?

A:       The US Wound Registry  and the US Podiatry Registry are 2 of the 9 registries that make up the  Chronic Disease Registry. You can find information about them at: https://uswoundregistry.com/. In addition to reporting the Merit-based Incentive Payment System (MIPS) measures, you can report the following wound/ulcer and podiatry measures through one of these Qualified Clinical Data Registries (QCDRs):

·       Adequate off-loading of DFU at each visit

·       DFU healing or closure

·       Plan of care for DFU or VLU patients not achieving 30% closure at 4 weeks

·       Adequate compression of VLU at each treatment visit, appropriate to arterial supply

·       VLU outcome measure: healing or closure

·       Appropriate use of HBOT for patients with DFUs

·       Appropriate use of cellular or tissue-based products (CTPs) for patients aged 18 years or older with DFU or VLU

·       Outcome measure: Major amputation in Wagner Grade 3,4, or 5 DFUs treated with HBOT         

·       Patient reported nutritional assessment and intervention plan in patients with wounds and ulcers

·       Non-invasive arterial assessment of patients with lower extremity wounds or ulcers for determination of healing potential

·       Patient reported experience of care:  Wound outcome

·       Outcome measure: Non-lower extremity pressure ulcer (PU) healing or closure

·       Patient reported outcome of late effects of radiation symptoms following treatment with hyperbaric oxygen therapy (HBOT)

·       Outcome assessment for patients prescribed ankle orthosis for ambulation and functional improvement

·       Outcome assessment for patients prescribed foot orthosis for ambulation and functional improvement

·       Improvement in quality of life from partial foot, prosthetic

 

Q:       You mentioned that Physician Compare does not list the physician’s performance for all the reported quality measures. Are any of the of the wound/ulcer quality measures listed on Physician Compare?

A:       Yes. When the Physician Compare website was recently updated, it included performance data on 1) 12 standard quality measures from the MIPS and 2) 11 specialty-specific measures developed by various QCDRs. Even though more than 40 QCDRs exist, the 11 specialty-specific measures were selected from only 6 QCDRs. The wound/ulcer management specialists who reported their quality measures via the U.S. Wound Registry were excited to learn that 3 of the quality measures reported via that registry were included on the Physician Compare profile pages. These quality measures are:

·       Adequate offloading of diabetic foot ulcer at each treatment visit

·       Adequate compression of venous leg ulcers at each treatment visit

·       Vascular assessment of patients with chronic leg ulcers

 

Now it is up to wound/ulcer management physicians/QHPs to report their performance of the wound/ulcer quality measures through a pertinent QCDR. Otherwise, the CMS will delete the very measures that your specialty worked so hard to get approved. For example: The CMS requires enough physicians/QHPs to report QCDR quality measures for 3 years in order to set national benchmark rates. Then the measures are eligible to be reported on Physician Compare. If benchmarks cannot be set, the measures are deleted and will no longer appear on Physician Compare. You now have wound/ulcer quality measures that will measure your performance – use them – don’t lose them. Be proactive about keeping your wound/ulcer-specific quality measures in Physician Compare!