Is Physician Quality Reporting System Worth the Cost to Report to Center for Medicare and Medicaid Services?

Abstract

Background: The Center for Medicare and Medicaid Services (CMS) has proposed a move to payment based on patient-reported outcomes (PROs), and failure to report on PROs will result in a penalty of 2% in 2016. However, the cost to the physician to collect PROs is not known.

Methods: Using data from the 2013 Medical Group Management Association Compensation and Financial survey and Center for Medicare and Medicaid Services reimbursement, a calculation was performed to determine the cost to the physician to report on PROs for patients undergoing total knee arthroplasty and total hip arthroplasty. Using Medical Group Management Association and Medicare fee for service rates, calculations were performed based on an annual volume of 200 Medicare operative cases (125 total knee arthroplasties, 75 total hip arthroplasties) with 1000 new patients (level 4) and 2000 established patients (level 3) visits. A range of start-up and annual costs necessary to collect PROs including hardware, software, and personnel costs was calculated and then compared with the calculated 2% Medicare penalty for failing to report PROs in 2016.

Results: The cost to collect PROs ranged from $47,973 to $56,288 which far outweighed the penalty of $2954 in 2016 for failing to report these measures.

Conclusion: With the move toward requiring surgeons to report PROs for reimbursement, the current financial model would prove to be cost prohibitive and the incentive to report PROs might be too costly to gain wide acceptance.

Keywords: arthroplasty; bundled; cost analysis; outcomes; payment; practice management.