Study: Only one-quarter of clinicians comfortable with value-based payment program
Clinicians are largely unprepared to meet the statutory requirements of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015, according to a survey by Haymarket Medical Education.
The survey, sent last month to a nationwide sample of clinicians, found that only about a quarter of the primary care and specialty physicians, PAs, and NPs polled were comfortable with the transition to QPP, which is set to offer Medicare and Medicaid reimbursements to doctors based not on volume of procedures, but on quality of care.
That's despite two years of educational campaigns by the Centers for Medicare and Medicaid Services (CMS) and various professional medical organizations in advance of QPP going into effect.
Moreover, CMS recently designated continuing medical education (CME) an “improvement activity,” allowing physicians who complete programs from accredited education providers and who substantiate their performance improvement in this area to count those credits toward their state requirements.
The HME study also found confusion among those who will implement QPP. Seventy-two percent of respondents said they are uncomfortable with the program, and 76% said their staff does not understand it. Most respondents indicated they understand the effect QPP will have. Two-thirds of respondents said they expect the transition to have a “very large impact” or “somewhat of an impact” on their practice, and 80% said they expect a similar impact on the healthcare system as a whole.
Matthew Holland, GM of Haymarket Medical Education and myCME, said the changes will affect clinicians across the board.
“Whether you're a small or solo group practice, urban, rural, or suburban, the large majority were not really aware of the impact of the policy and the changes, and weren't really prepared for the implementation,” he said, adding that the findings are a wake-up call for government agencies to consider their role in educating around this policy change, too.
Holland noted that solo and rural clinics were found to be particularly ill-equipped to handle the reporting requirements, since they tend to be more focused on running their practices. Larger institutions, like those that are part of a health system or accountable care organization, have the benefit of more resources to draw from, he said.
Regardless of size, most of those surveyed didn't have glowing reviews for QPP. “It is misguided and defeats the idea of quality medicine by reducing it to a series of arbitrary check marks and standards that does little to improve health,” one physician commented.
CME has been shown to improve both patient outcomes and quality of care, and payment has become part of the equation, as well, he said. “For the first time, there's a true alignment between value, quality, and education,” Holland observed.
And grantors have been interested to back such programs. Holland said he and his team conducted a two-year initiative with Celgene at the Moffitt Cancer Center on the treatment of deep vein thrombosis in oncology patients. They pulled charts, looked at data, and ultimately designed education for the gaps they found, reporting their findings back to Moffitt.
Other organizations support educational initiatives around quality improvement, as well. Broadly, in 2016, the latest year for which data are available, the pharmaceutical industry spent $704 million on certified CME, up 1.5% from the year before.
Holland said a priority is to ensure CME is being used to its full potential, with education delivered in formats that meet the demands of clinicians' schedules through short video programs and mobile-only activities that are specialty-specific, for instance.
“We're really trying to figure out how we can develop meaningful content and programs in a way that makes it consumable, given all the other competing priorities that clinicians are dealing with,” he said.
Healthcare providers are eager to improve: HME's survey found that two-thirds of respondents were either “very interested” or “somewhat interested” in CME activities that will help them with the new QPP measures.
“It can really add a lot of benefit and value to the clinician,” Holland said. “Now let's make sure that it gets adopted and used in a way that can help them obviously improve the quality of care.”
Editor's note: HME and MM&M are owned by the same parent company, Haymarket Media.