The Centers for Medicare and Medicaid Services' plan to revolutionize physician compensation needs to refine its information technology testing, a new report has found.

The Health and Human Services inspector general's office examined development of CMS's Quality Payment Program — which seeks to reshape physician compensation model from the Sustainable Growth Rate to a merit-based platform — finding that while early crafting of the program has shown promise, CMS officials will need broader IT and technical support to back up its goals.

Related: Read the report

The program is set to begin its first performance year on Jan. 1, 2017, with QPP payment adjustments beginning two years later.  

The December report examined the early implementation of the program, finding that CMS officials had adequately established key management priorities and regulations for the early implementation of the QPP.

But the OIG also found two vulnerabilities in the program that CMS officials need to address, centering on both IT support within the program and early adoption of it by physicians.

"CMS has built a promising foundation for managing the initial transition to the QPP," the report said.

"However, its ability to ensure clinicians' readiness to participate in the program and develop the necessary IT infrastructure will help determine whether the QPP succeeds in its goal to promote quality and value of care."

To stand up the QPP, CMS officials partnered with the U.S. Digital Service to establish agile IT methodology to build the program's data infrastructure, as well as create a Blanket Purchasing Agreement to help speed the IT procurement process.

Since agile development is based on fast, iterative development, the inspector general advised CMS officials to start rolling out sprint contracts to procure IT services quickly in 2017.

The speed of the procurement also means CMS will be working with a larger pool of contractors, requiring broader oversight enforcement from the agency to keep up with the acquisition process and increased staff numbers to manage the project, the OIG said.

And while procurement is one hurdle, CMS must still build and test its back-end IT systems to ensure they can handle the glut of information coming from physicians.

The report noted that CMS established an informational website about QPP in October, but the agency still has to enable individual accounts for physicians enrolled in QPP and test the systems that manage them.

"Such testing is critical; a poorly functioning identity management service could impede clinicians’ ability to successfully submit data, receive performance feedback reports, and conduct other QPP activities using the Portal," the OIG said.

"To mitigate this risk, CMS plans to encourage clinicians to voluntarily register for a QPP account several months prior to the first deadline for data submission."

The "soft rollout" plan should give CMS officials time to mitigate development risks over the course of 2017 — and by also using its current legacy systems as a backup for data submission — though the OIG said that such a large IT system will require extensive back-end testing to ensure QPP remains on schedule.

"In the past, CMS has sometimes experienced delays and complications related to major IT initiatives, such as those required for the continued operation of Medicare Part D and HealthCare.gov," the report said.

"If the complex systems underlying the QPP are not operational on schedule, the program will struggle to meet its goal of improving value and quality."

Since physician adoption of QPP is critical to the program’s success, the report also called for "ramped up" training, especially for rural physicians and small medical practices, in addition to clinician readiness monitoring.

In response to the report, Acting CMS Administrator Andy Slavitt noted CMS’s engagement efforts in the development and testing of QPP and said the agency is committed to "continuing to engage with and provide assistance to clinicians, and to optimize backend IT systems support," as it moves forward with the program.

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