Trendspotter: New technology choices will help you with PQRI

By Ken Terry

Welcome to Trendspotter, a new weekly blog feature that bears the same name as the monthly column I’ve been penning for Physicians Practice over the past year. In this blog, I am not only going to report the news, but also will endeavor to supply some insights that you might find useful. Please post a comment if you agree or disagree with any of my entries, and also feel free to contribute your own insights and information.

That said, let’s turn to this week’s topic: CMS’ Physician Quality Reporting Initiative, or PQRI, as it’s known to most of you. This is going to become more important to practices, and not just because of the 2 percent Medicare bonus that you can now receive if you report quality data to CMS successfully.
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If Congress passes healthcare reform legislation, it may well include new Medicare reimbursement methods like those in the current Senate bill. Under that measure, after tracking the utilization of every physician in the Medicare program, CMS would be empowered to reward doctors who provide high-quality, cost-efficient care, and punish those who don’t. While we don’t yet know how big the carrots and sticks will be, it’s clear that the quality piece will be based on measures like those of PQRI. So it’s time to start reporting this data, if you’re not doing it already.

According to a new CMS report, more than 85,000 physicians and other eligible professionals met PQRI requirements in 2008 and received a total of $92 million and change. (Individual payments averaged more than $1,000.) This was viewed as a smashing success, considering that only 56,700 eligible professionals received incentives in 2007, and that those payments totaled just $36 million.

But the latest figures suggest a story that is not quite as upbeat as CMS’ spin.

Let’s start with the fact that of the 153,600 providers who applied for PQRI incentives in 2008, 45 percent did not make the cut. Of course, this has nothing to do with their relative scores on these measures. Their ability to obtain the government payments depended purely on whether they met the statutory requirements for data submission. So we can assume that they or their staffs did something wrong, such as putting in the wrong G codes or selecting the wrong patients for the measures they were submitting data on.

This was also a serious problem in 2007, and not just on the physician side. CMS has just announced that, after resolving several “data issues,” it will make payments to 3,900 physicians who were erroneously excluded from the 2007 incentive pool.

One reason for the improved 2008 performance is that physicians were allowed to report their PQRI data through approved electronic registries run by third parties. About 8 percent of those who applied for the PQRI incentives availed themselves of these services, and nearly all of them received bonus payments.

The 2009 PQRI program raised the incentive from 1.5 percent to 2 percent of allowed Medicare payments. Fifty-two new measures were added, raising the total to 153 and broadening the areas in which physicians can qualify for bonuses.

In the 2010 PQRI round, the incentive will again be 2 percent , and 36 new measures have been added. For the first time, practices will be able to qualify for incentives at the group level, rather than the individual provider level. And, most important, CMS will begin accepting data from “qualified” EHRs on 10 of the measures and applying that data to meeting the requirements for PQRI incentives.

Because the ability to send quality data to CMS from your EHR is one of the criteria for “meaningful use,” you must do this if you want government subsidies for your EHR investment. Moreover, being able to use your EHR to collect and submit performance data automatically, instead of having to enter G codes in the billing system, will take a burden off of many physicians and their staffs. When more measures are added to the EHR reporting menu, it will become a no-brainer to submit data in return for a 2 percent pay bump.

Ken Terry is a New Jersey-based freelance writer and the author of the book "Rx for Health Care Reform." In his weekly Trendspotter column, Ken is looking out for trends and changes that may affect your practice.