Legislative: Quality control: 2008 PQRI includes enhancements, incentives for participation

September 1, 2008

The Centers for Medicare & Medicaid Services (CMS) has announced payment of more than $36 million in bonus payments to many of the more than 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI).

Key Points

The Centers for Medicare & Medicaid Services (CMS) has announced payment of more than $36 million in bonus payments to many of the more than 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI).

The agency also announced that PQRI will continue in 2008 with several new features that provide eligible professionals with more flexibility in collecting and sending PQRI data to CMS.

Among these new features is an expanded set of quality measures, including measures to gauge the use of electronic health records and electronic prescribing technologies.

Incentives

"Creating a value-based purchasing system is a critical way to improve our healthcare systems. By collecting quality data, healthcare providers can use the information to improve the quality care of beneficiaries," says Michael Leavitt, Health and Human Services secretary.

The agency also announced it will conduct a three-month test of 11 quality measures for possible inclusion in the 2009 PQRI program, including three related to melanoma. While there will be no bonus payments for participating, dermatologists are encouraged to do so.

Meanwhile, CMS says physicians, physician group practices and other PQRI-eligible professionals should have received their 2008 payments by August. The average incentive amount for individual professionals is more than $600, and average incentive payment for a physician group practice is more than $4,700, with the largest payment to a physician group practice totaling more than $205,700, the agency says.

"These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for healthcare services," CMS acting administrator Kerry Weems tells Dermatology Times.

"We all can agree that the current payment system needs to be reformed to pay for high-quality care rather than continuing to pay for the volume of services. The PQRI has proven to be a successful step toward establishing a value-based purchasing program for physicians," Mr. Weems says.

Program participation

The PQRI is a voluntary program, and physicians and other eligible professionals are able to receive bonus payments of 1.5 percent of their total allowed Medicare charges, subject to a cap, by satisfactorily submitting quality information for their services.

More than 109,000 professionals participated in 2007.

While the 2007 PQRI was a positive step toward reporting quality information, the 2008 PQRI program included significant enhancements in terms of the scope of measures that could be reported, the opportunity to receive incentive payments for the entire year, the ability to report measures within a group for a specified number of patients and the use of registries to report quality measures, according to CMS.

The 2008 PQRI program has grown to include 119 quality measures, which were published in the Physician Fee Schedule for 2008. Leading physician organizations, including the American Academy of Dermatology, participated in their development.

Nearly all of the measures are clinical performance measures, although two structural measures focus on the use of electronic health records and electronic prescribing technology.

Medical registry

As an alternative to submitting 2008 PQRI quality data as part of their Medicare claims submissions, CMS says eligible professionals may choose to report data on quality measures through a medical registry, which will then report the data to CMS. Those who report through a registry will still qualify for an incentive payment.

For 2008, eligible professionals who meet the statutory criteria for satisfactory submission of quality data on services furnished during the reporting period will earn an incentive payment of 1.5 percent of their total allowable charges for Medicare Physician Fee Schedule (MPFS)-covered professional services furnished during that same period. CMS is also testing the submission of PQRI data from electronic health records.

The submission of test data began in July 2008 and will end Dec. 31, 2008, for electronic health records.

To be eligible for an incentive payment for 2008 PQRI, professionals can choose from among nine options for submitting PQRI data - whether through claims or through a registry.

For 2008, eligible professionals can choose to begin their reporting periods on Jan. 1 or July 1, 2008 - as long as they report information through Dec. 31, 2008, for either option, CMS says.

Former congressional aide Bob Gatty covers Washington for businesses specializing in healthcare and related issues.He has written Dermatology Times' Washington Report for more than 20 years, and welcomes comments and suggestions.Mr. Gatty is available at: bob@gattyedits.com

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