Government

Medicare quality reporting called a promising start

The program continues this year with added quality measures. Government officials expect it to be extended through 2009 and are seeking to include new assessments.

By Doug Trapp — Posted March 17, 2008

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About one in six eligible physicians and other health professionals participated in a new Medicare quality reporting program during its first five months, according to preliminary figures from the Centers for Medicare & Medicaid Services. About half of them are on track to get up to a 1.5% bonus for their efforts.

Doctors and CMS were generally encouraged by the early participation results for the 2007 Physician Quality Reporting Initiative. Physician organizations credited CMS and their own education efforts for the results. But one doctor expressed concern that the 1.5% bonus might not be enough to attract widespread doctor participation.

About 99,000 health professionals -- 16% of those eligible -- reported information on at least one of the PQRI's 74 measures between July 1, 2007, and Nov. 30, 2007, according to a Feb. 21 letter from CMS Acting Administrator Kerry Weems to Sen. Max Baucus (D, Mont.). The rate is expected to climb higher because reporting for the 2007 PQRI continued until Feb. 29. The program has been extended through 2008 and was expanded to include 119 measures.

These early numbers show that PQRI is off to a promising start, said American Medical Association Board of Trustees Chair Edward L. Langston, MD. He said it's important to keep the program voluntary and noted that 80% of PQRI's measures were developed by the AMA-convened Physician Consortium for Performance Improvement.

Various health professionals accepting Medicare payment were eligible for the program. These include physicians, physician assistants, physical therapists and nurse practitioners. Professionals who reported on at least three measures and applied each one to at least 80% of the patients who fit that category were eligible for a bonus of up to 1.5% on all of their charges under the Medicare fee schedule. The PQRI's first payments are expected later this year.

Participation was strongest among emergency physicians, ophthalmologists and anesthesiologists, judging by the quality measures with the highest response rates, said CMS spokeswoman Ellen Griffith. The agency did not elaborate on which health professionals saw low participation in the initiative, but Griffith said the program is off to a good start. "On the whole, we are very pleased with the implementation of the program and the response of physicians to it in the short time it has been in operation."

CMS expects the program to continue in 2009, subject to congressional appropriations, Griffith said. The agency has begun accepting quality measure suggestions for possible inclusion in PQRI for 2009.

Some specialty society officials said the PQRI was generally well implemented. But one suggested that the program might more popular if its bonus payment was large enough to make up for the time and effort needed to report the quality measures.

"At 1.5%, it's not getting a lot of people's attention," said Dennis Beck, MD, chair of the American College of Emergency Physicians' quality and performance committee. "To have real meaning, pay-for-performance programs probably have to have a more substantial economic impact." He suggested that a 5% to 10% bonus might attract more attention.

Dr. Beck noted a reporting wrinkle. A substantial number of billing companies and physicians' billing software experienced difficulty handling one of the PQRI codes needed to report the results. Still, he said ACEP generally supports the concepts behind PQRI.

Other physician officials representing anesthesiologists and ophthalmologists said they and their colleagues had not experienced many PQRI implementation problems.

The American Society of Anesthesiologists "has been aggressive about informing and educating our members and is not surprised that they have become engaged in large numbers," said Alexander A. Hannenberg, MD, ASA first vice president.

Ophthalmologists could choose from eight PQRI quality measurements, which actually made it a little tough to decide which measures to track, said William Rich, MD, the American Academy of Ophthalmology's medical director of health policy. The standards were important ones, he said. "The measures reflected large public health issues in ophthalmology: diabetes, glaucoma, macular degeneration and cataracts."

None of the three specialists were surprised to find out that their colleagues were active in reporting in the PQRI. Dr. Beck said physicians working in hospitals are accustomed to dealing with quality reporting. Dr. Rich noted that the AAO developed evidence-based practice standards more than 20 years ago.

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ADDITIONAL INFORMATION

PQRI participation

Last month, the Centers for Medicare & Medicaid Services released early participation figures for the Physician Quality Reporting Initiative. The results cover the program's first five months, which ended on Nov. 30, 2007. CMS found:

  • 99,000, health professionals -- 16% of those eligible -- participated in PQRI, meaning they submitted data on one of the program's 74 quality standards at least once.
  • Emergency physicians, ophthalmologists and anesthesiologists took part in PQRI more frequently than others, judging by the quality measures with high reporting rates.
  • More than half of participants are on track to satisfy the requirement of reporting at least three measures and applying each one to at least 80% of the patients who fit that category. This means they will be eligible for up to a 1.5% bonus payment on all Medicare fee-for-service charges.

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External links

Centers for Medicare & Medicaid Services overview of the Physician Quality Reporting Initiative (link)

American Medical Association PQRI participation tools (link)

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