What You Don’t Know Could Hurt You: Check This CMS Report ASAP

Some of the best conversations happen in elevators. I had just left the American College of Cardiology Cardiovascular Summit and was dashing to my room to grab my bag, check out and depart for home. No time to chat, but I couldn’t resist when the man who rushed into the elevator after me asked, “Were you at the QRUR session? Wasn’t it excellent?”

Yes, workshop faculty Cathie Biga, RN, MSN, and Geoffrey Rose, MD, had crammed more information into the 45-minute workshop than my brain could manage. Every seat had been occupied, and a bunch of us had piled into the back, willing to stand for the opportunity to listen. 

“They don’t teach us this!” said the cardiologist during the elevator’s ascent. “I had no idea! I bet 90 percent of us don’t.”  

He was referring to one of Biga’s urgent instructions to attendees: Go to PECOS.* See how you are categorized. Download your s-QRUR** report. Make it a priority to check these and other CMS reports about you and your practice. The information you find could dramatically impact how you fare in the world of value-based healthcare.

It may be more important than ever to keep an eye on these reports now, as the healthcare system has “one foot in volume and the other in value.” That’s how a few of the Summit’s speakers described the transition healthcare is undergoing. Straddling two systems isn’t a comfortable place to be, they indicated, but you can be successful. Especially if you are proactive.

“I called home, and told them, we need to do this,” my fellow traveler said. “I’m an interventional cardiologist. If CMS thinks I’m an internist… .”

He shuddered, thinking how his resource utilization, those of an interventional cardiologist performing expensive tests and procedures, might look next to those of an internist and what the perceived difference might mean for his performance scores.

On Monday morning, he vowed, he would meet with his practice administrator, just as Biga advised, and get these things taken care of.  The interventional cardiologists in his practice would be designated as such. I gathered he would urge his electrophysiologist and general cardiologist peers to join him in this step. The worst scenario, said Biga, would be an electrophysiologist lumped in with family practice or internal medicine.

The clock’s ticking to complete this task. Get it done before June, Biga warned, because in July, the PECOS records will be pulled and providers’ costs will be benchmarked for comparison. The figurative train—like others that have for years loomed large in healthcare leaders’ lectures—will have left the station, leaving incorrectly categorized specialists wondering why their resource utilization is being unfairly compared to that of generalists. Apples and oranges tossed together in the same train car.

Update PECOS now, said Biga, but don’t check it off your to-do list. Calendar yourself or your practice administrator to check it in June and then again the first week of July, just in case. You want to be sure your changes stuck. 

The doctor and I exchanged cards. “If I call you in a week, will you tell me how it went, how much you corrected in your reports?” I asked.

“Give me two weeks,” he said, “but I guarantee, we’re doing it.”

*Click here for more information about the Provider Enrollment, Chain and Ownership System (PECOS) reports.

**Click here for more information about Supplemental Quality and Resource Use Reports (s-QRUR) reports.