PQRS(ucker)

16%.  That's how many "clinicians" who were eligible to get a bonus for "quality" from Medicare decided to embark on this unfunded data hoarding mission.  For those of you who don't know what PQRI is,  it's another alphabet soup program presented by the Medicare National Bank in an effort to make doctors and all other "clinicians" believe that their quality is worth hard American (declining) dollars.

Physician Pay For Performance  (PQRI) is a voluntary (at least for now) program where physicians can chose to report certain quality measures determined by the Medicare National Bank.  There were  74 of them for 2007.  In 2008,  114 measures will be reportable.  For hospitalists, eleven quality indicators were reportable.   Our group reports.  We have chosen four indicators.   Whether a patient has an advanced directive.   Whether a stroke patient or a coronary artery disease patient is discharged with anti platelet therapy.  And whether rehab was ordered for stroke patients.  Now  the current set up of the program is pretty silly.  I am given options like:  The patient is on anti platelet.  The patient is not on anti platelet for a medical or social reason.   Or the ever popular answer:  The patient is not on anti platelet and no reason is given or documented.  You see,  I get credit just for reporting.  Not for reporting quality data.

I don't get credit/money for making sure the patient is on aspirin.  I get credit simply for responding that they aren't, and I don't have to give a reason why.  How is that quality?  I believe that the Medicare National Bank is using this 2007 class of graduating Sucker Physicians to get a baseline.  From here, the base line will determine whether the program shows trends toward improvement.  I also believe, that eventually this voluntary program will not be voluntary.  And failure to join will result, not in quality bonus, but a reduction in payment.  Like the Medicare National Bank has done with the hospitals.  Start with bonus.  Then implement the fee reductions in non voluntary fashion.

Let me run you some numbers and show you why only 16% of doctors and other clinicians signed up for this voluntary program.  Let us imagine that a primary care doctor has a practice of 50% Medicare patients.  Let us say he generates revenue for the entire year of $400,000.  If half his revenue is Medicare,  $200,000 would be generated.  Assuming he does all the reporting correctly for all of 2007,  his bonus would be 1.5% of 200K,  or $3,000 for the entire year.  Let us assume a total tax burden of 33%. After tax take home for the year of effort for Dr PCP is $2,000.

$2,000 for the entire year.  Imagine for a moment if the primary care doctor saw 5,000 encounters for the entire year.  Let us imagine 50% of them were Medicare.  You have 2,500 Medicare encounters.  Let us assume that an office worker only spends 3 minutes on every single one of those 2,500 Medicare encounters filing the paperwork or electronically submitting every single one of those quality measures.  3 minutes.  I can't imagine anything taking only 3 minutes.  But let us assume it does.  With 2,500 Medicare encounters, at 3 minutes a pop, you have yourself 7,500 minutes of unfunded paper work, to add to the mounds already present in the daily activity of the office.  That is the equivalent of 125 hours of work for a calendar year.  Imagine for a moment that this clerk is worth $10 an hour.  That works out to $1,250.  But you, as an employer must also pay 6.2% social security tax and 1.45% medicare tax.  So, tack on another $100.  As a physician, it would cost you $1,350 for a $10 an hour clerk to file every single PQRI quality measure for 2007.  In return, assuming you did everything right,  you would get an after tax net of $2,000 from the Medicare National Bank.

And of that $2,000, you, Dr Sucker, would net $650.  And that doesn't include the 3 minutes of unfunded time the doctor spends on every single one of these patient encounters.

I guess I'm The Happy Sucker.  I think I'll consider it my version of the recession busting, dollar diving tax rebate