New reporting options “will make it easier for eligible professionals to participate [in the Physician Quality Reporting Initiative (PQRI)] and receive feedback on their performance,” according to CMS. In late 2007, Congress made changes to the PQRI with the passage of the Medicare, Medicaid, and SCHIP Extension Act (PubLNo 110-173) (Extension Act), which provided new flexibility for submitting data and implemented registry-based reporting. These changes “will ultimately improve the services provided…[b]y providing more opportunities to submit information about the quality of care provided to Medicare beneficiaries,” CMS Acting Administrator Kerry Weems said.
2008 PQRI program. Implemented in 2007, the PQRI creates a quality reporting system that includes an incentive payment for satisfactorily reporting data on quality measures for covered professional services provided to Medicare beneficiaries. The 2008 PQRI program allows the use of 119 quality measures that were included in the Medicare physician fee schedule for calendar year 2008. Of those measures, 117 are clinical performance measures, such as the percentage of patients who received necessary cancer screenings and flu shots, and two are structural measures. The structural measures focus on the use of electronic health records and electronic prescribing technology.
New reporting options. The Extension Act authorized PQRI transitional bonus payments in 2008 without the cap that applied to incentive payments in 2007. It also required the Secretary of HHS to establish alternative criteria and reporting periods for both the reporting of groups of measures and the use of registry-based reporting.
For 2008, in addition to submitting PQRI measure data as part of their Medicare claims submissions, eligible professionals may report data on quality measures to a medical registry, which will report that data to CMS. “[R]egistry-based reporting will provide more ways for eligible professionals to qualify for an incentive payment,” CMS noted.
Another change under the 2008 PQRI is new reporting periods for eligible professionals who report using measures groups. Participants may now start reporting in July 2008 and be eligible to earn an incentive payment for the 2008 PQRI program.
Participation data. Preliminary participation data indicates that the program has been successful. CMS believes that more than half of the 100,000 professionals who submitted PQRI data at least once in 2007 will receive an incentive payment. “We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting program,” Weems said. He added, “These new options will help all health care stakeholders take the positive steps necessary to ensure that beneficiaries continue to get high quality care.
CMS Press Release, April 17, 2008.
Visit our News Library to read more news stories.