Provider Incentive Programs: Deciphering the Legislative Landscape

As I’ve spent more time thinking about the ARRA, I’ve reflected on the multitude of other governmental “stimulus” programs that are available to providers to help improve the quality, safety, and efficiency of healthcare delivery. If providers are unable to navigate the morass of legislation that is the byproduct of all these programs, then it will be increasingly difficult for either the government or the provider community to garner the intended benefits of these programs.

Some of the governmental programs currently in place include: (a) CMS’s Physician Quality Reporting Initiative (PQRI), (b) the e-Prescribing initiative authorized in Section 132 of the Medicare Improvements for Patients and Providers Act of 2008, (c) CMS’ Hospital Compare project, (d) the anti-kickback safe harbors / STARK exceptions for e-prescribing and electronic medical records, and (e) the American Recovery and Reinvestment Act of 2009 (ARRA).

The complexity of these programs has, understandably, caused a significant level of confusion in the healthcare marketplace as providers have struggled with understanding the overall program framework let alone trying to implement strategies that allow them to maximize the benefits and incentives associated with such programs. In short, providers are confused and stymied by the number and complexity of programs available to them in today’s legislative landscape.

Do most providers have the resources in place in order to develop the strategic approaches necessary to leverage the incentives offered in these programs and do it efficiently?

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