LAS VEGAS — Medicare's Physician Quality Reporting Initiative could be the basis for pay-for-performance programs down the road, Dr. Michael A. Granovsky said at a meeting on reimbursement sponsored by the American College of Emergency Physicians.
And, in the near term, the Centers for Medicare and Medicaid Services, which administers the program, could begin publishing whether doctors have successfully participated in PQRI.
“I think PQRI is here to stay,” said Dr. Granovsky, president of Medical Reimbursement Systems Inc., based in Woburn, Mass. “I think this is the first leverage that CMS is developing to track quality and apply it on the reimbursement side. And I think they want a bigger and bigger stick over time.”
In 2010, physicians in PQRI are eligible to receive up to a 2% bonus payment based on all of their Medicare Part B charges if they report successfully 80% of the time on at least three individual quality measures in 2010.
Over the last several years, CMS officials have laid out their vision for value-based purchasing, emphasizing their desire to pay physicians and hospitals for quality of care, rather than simply for volume of services, and to avoid unnecessary costs. PQRI is widely seen as the first step in that transition, he said.
Although the pending federal health care reform effort would include more moves in that direction, CMS already has the tools it needs through prior legislation to make significant progress in that direction, Dr. Granovsky said. “Medicare already has the regulatory muscle to put this in place,” he said.