LAS VEGAS — There's a growing interest among physicians in Medicare's Physician Quality Reporting Initiative, launched in 2007, but it isn't because of the 2% bonus payments available this year.
More likely it's the possibility that the Physician Quality Reporting Initiative (PQRI) 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, 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.”
Under the PQRI program in 2010, physicians 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. They also can report on measures groups.
This year, the program includes 179 measures and 13 measures groups. In 2008, the average individual physician who successfully reported quality data received about $1,000, Dr. Granovsky said. Payments are expected to be somewhat higher this year, because the bonus was increased from 1.5% to 2%.
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, Dr. Granovsky said.
Although the pending federal health care reform effort would include more moves in that direction, the 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.
Medical groups that choose to participate in PQRI must commit to it, Dr. Granovsky added, because it requires a great deal of data collection and reporting. Groups also should collaborate closely with their billing company.
A regular internal auditing process will also help medical groups ensure that they are getting the most out of their reporting efforts, Dr. Granovsky said.
One of the criticisms of the PQRI program is that it takes about 18 months to get feedback reports from the CMS, making it nearly impossible to detect problems in a timely manner. However, a monthly internal audit will help alert groups if they have a data file transfer problem that could prevent their PQRI claims from being processed, he said.