Consumer Assessment of Healthcare Providers and Systems for Physician Quality of Reporting System (CAHPS for PQRS) Survey
The Centers for Medicare and Medicaid Services (CMS) recognize the value of patient feedback in helping eligible professionals (EPs) and group medical practices assess the quality of care they provide. By partnering with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Consortium, CMS has created a CAHPS for PQRS survey instrument to measure patients’ perceptions of the quality of care they receive. Although The RAND Corporation collected survey data for the 2014 measurement, Professional Research Consultants, Inc., (PRC) is eligible to conduct the survey on behalf of medical groups for the 2015 measurement and beyond.
PRC is always anticipating the newest information coming down the CMS pipeline, and details about CAHPS for PQRS have kept the team on its toes. PRC has worked with the CAHPS Consortium for many years, sharing feedback as the CG-CAHPS core was developed and serving as a recognized voice for other survey vendors. More than 30 years of industry experience has fueled PRC’s expertise and shaped its opinions and suggestions for survey design and implementation. The client relationship management staff is eager to help clients navigate the changing reporting landscape and create a custom research plan, with the CAHPS for PQRS measurement at its core, to meet medical groups’ and eligible professionals’ need to measure patient perceptions of physician quality. Clients can also count on the operations team to deliver excellent service based on its years of experience collecting data for the CAHPS for ACOs (Accountable Care Organizations) program, which uses the same, blended mail and telephone methodology. Download the brochure.
How does this process work?
When EPs and group practices report on the quality metrics that PQRS measures, they can also quantify how often they meet particular metrics. Beginning in 2015, CMS will penalize individual EPs and group practices that do not report data on PQRS quality measurements for the Medicare Part B Physician Fee Schedule covered professional services. This means that CMS will apply a negative payment adjustment to providers who do not satisfy PQRS reporting requirements, which will give providers an incentive to report their data. The idea is to improve the quality of care by ensuring that patients get the right care at the right time.
How providers use the CAHPS for PQRS survey depends on how their practice is structured. Groups with 25-99 EPs under a single Taxpayer Identification Number (TIN) have the option of adding the CAHPS survey to their clinical performance research. Groups with more than 100 EPs are required to implement the CAHPS for PQRS survey.
The RAND Corporation administered the initial data collection in 2014 for qualifying groups. 2015 was the first year that medical groups could partner with survey vendors to collect data. Survey administration for the 2015 program year took place from November 2015 to February 2016. The research approach mimics the CAHPS for ACOs program and uses a blended methodology that mixes data collection by mail with data collected during one-on-one conversations conducted by professional interviewers over a 12-week period. CMS draws the required sample of 860 Medicare beneficiaries who filed claims during the designated sampling period. Smaller medical practices will be allowed to sample a census as long as they meet the minimum sample size that corresponds to the number of EPs in the practice. Physician Compare will be updated each fall with the previous year's results.
What does CAHPS for PQRS survey measure?
The CAHPS for PQRS survey stems from the CG-CAHPS core survey and incorporates several supplemental questions to be applied to the Medicare Fee for Service Physician Payment System.
|12 Summary Survey Modules|
|Getting Timely Care, Appointments, and Information||9 questions|
|How Well Providers Communicate||7 questions|
|Patients’ Rating of Provider||1 question|
|Access to Specialists||4 questions|
|Health Promotion & Education||6 questions|
|Shared Decision Making||10 questions|
|Health Status/Functional Status||9 questions|
|Courteous and Helpful Office Staff||2 questions|
|Care Coordination||5 questions|
|Between Visit Communication||2 questions|
|Helping You to Take Medication as Directed||5 questions|
|Stewardship of Patient Resources||1 question|
What is the Value Modifier?
Much like the Hospital Value-Based Purchasing program, the Physician Value Modifier incentivizes clinicians to deliver high-quality patient care. Legislated in the Affordable Care Act, the Value Modifier (VM) is designed to hold physicians accountable for the quality of care they deliver. Understanding the VM and the federal government’s Physician Quality Reporting System (PQRS) is important because, together, they affect the payments physicians receive through the Medicare Fee for Service Physician Payment System. Combinations of quality and cost scores will either reward or penalize physicians for their performance.
The Value Modifier is aligned with and is based on participation in PQRS. Medical groups’ performances in program year 2015 will be the source of payments in federal fiscal year 2017. Solo practitioners and medical groups with more than two EPs are subject to incentive adjustments through the Value Modifier model.
The PQRS is organized around six National Quality Strategy (NQS) domains: (1) Patient and Family Engagement; (2) Patient Safety; (3) Care Coordination; (4) Population/Public Health; (5) Efficient Use of Healthcare Resources; and (6) Clinical Process/Effectiveness. When medical groups register to participate in the PQRS, they choose nine measures across three of these six domains. Failure to register and participate could result in a 2 percent reduction in reimbursements for 2016 and 4 percent reduction in 2017, depending on the size of the group.
- Registration is open from April 1 to June 30, 2016.
- Identify how many EPs are in the group’s TIN.
- Decide which PQRS clinical measures to report.
- Complete and submit the 2016 CAHPS for PQRS Survey Vendor Authorization form at the end of the summer.
Because the CAHPS for PQRS program is an annual measurement of patient experience, it is important to look for research consultants who are high-touch, high-tech partners, not vendors. PRC is eager — and exceptionally well-qualified, with a track record of timely reporting and excellent customer service — to help medical groups of all sizes design a custom survey from the CG-CAHPS platform to evaluate healthcare providers on an ongoing basis. If you have any questions about clinicians or medical groups, please contact us.