Quality reporting: How effective is PQRI?

April 1, 2008

The voluntary Physician Quality Reporting Initiative (PQRI), which began in 2007, may be a forerunner of a mandatory pay-for-performance from the Centers for Medicare and Medicaid Services (CMS). Under the PQRI regulations, a physician reports on specific best medical practices he follows. For example, under the PQRI, in 2007, dermatologists who asked patients with a history of melanoma whether they had seen any changes in moles or lesions, did full body exams on those patients and recommended patients do regular skin exams, and then reported they had followed those procedures in 80 percent of their melanoma patients, would earn 1.5 percent of their total CMS reimbursements as a bonus.

Key Points

Under the PQRI regulations, a physician reports on specific best medical practices he follows. For example, under the PQRI, in 2007, dermatologists who asked patients with a history of melanoma whether they had seen any changes in moles or lesions, did full body exams on those patients and recommended patients do regular skin exams, and then reported they had followed those procedures in 80 percent of their melanoma patients, would earn 1.5 percent of their total CMS reimbursements as a bonus.

For 2008, no specific dermatological practices were approved for the PQRI, because the chosen criteria were approved after the deadline, and the only way dermatologists can participate this year are with EMR record-keeping and e-prescribing.

Some doctors reported their practices had participated in the program, while others haven't. Several of the doctors say that, for the most part, they're still trying to figure out how the program works, but most say they aren't enamored of the program and question its value.

While participating in the program is supposed to be easy, with documenting the practices and adding certain CPT codes to the billing, some dermatologists say it hasn't worked out quite that simply.

Stephen B. Deliduka, M.D., F.A.A.D., is in a large multi-specialty practice in Elmhurst, Ill. He says following the best practices outlined in the PQRI hadn't required any change in the way he treated patients.

"Based on the way I practice, it wouldn't change the way I actually interact with patients, because the melanoma guidelines of the PQRI are standard in the way I treat melanoma patients anyway. So, from a practical standpoint, they don't impact the way I do things," Dr. Deliduka tells Dermatology Times.

But his department didn't end up taking part in the program.

"The rest of our group is participating, but our dermatology department isn't. We've had trouble gleaning the appropriate information from our electronic medical records to be able to report it on the appropriate form.

"So, technical infrastructure issues have been complicating our ability to do that," he says.

In Loma Linda, Calif., K. Dale Macknet Jr., M.D., F.A.A.D., started participating when the program started, but still isn't sure what it will mean to him.

"I started putting the codes on my bills last summer, but I'm still not sure if that's going to get me anything. I don't know what's going to happen.

"I performed all three of the PQRI tasks as a matter of routine. We were doing them anyway, we figured we might as well write in the codes," Dr. Macknet says.

But Dr. Macknet, who has been practicing with his father for eight years, doesn't like the program, even if it doesn't require anything outside of his normal way of practicing.

"I resent being told by something that 'This is the way you have to practice.' It's a voluntary program, but I don't get paid more if I don't do it. I'm penalized for being paid less. It's like taxes. It's voluntary, unless you don't pay them."

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