WASHINGTON — Data from the first 6 months of the Physician Quality Reporting Initiative are spurring improvements for the upcoming year, a Medicare official testified at a meeting of the Practicing Physicians Advisory Council.
In the summer of 2008, the Centers for Medicare and Medicaid Services paid $36 million in bonuses to 56,000 physicians for their 2007 reporting, said Dr. Michael T. Rapp, director of the quality measurement and health assessment group at the CMS. The average payment was $600 for 6 months' of data; for 2008 reports, the 1.5% bonus is likely to be around $800 on average, he said.
There will be a number of changes for reporting in 2009. In all, there will be 153 reportable measures, of which 52 are new, and 18 are reportable only through registries. There are seven measures groups: diabetes mellitus, chronic kidney disease, preventive care, coronary artery bypass graft surgery, rheumatoid arthritis, perioperative care, and back pain. Each group contains a number of measures; physicians can report these only as groups.
There will be nine ways for physicians to qualify for the 2% PQRI bonus in 2009, and they also can receive 2% bonus for satisfying requirements under the separate e-prescribing incentive program.
Under last year's Medicare Improvements for Patients and Providers Act, the CMS is required to eventually post on its Web site the names of physicians who satisfactorily report quality measures for 2009. That proposal has been controversial.
PPAC panelist Dr. Frederica Smith, an internist and rheumatologist in Albuquerque, N.M., called the idea a “terrifying concept,” given that it might appear that physicians who were not on the list did not care about quality.
And physicians had many problems complying with the CMS process for reporting measures in 2007, she noted.
Dr. Rapp agreed that the first phase of the program had been frustrating. But “the way it was for 2007 doesn't mean that's the way it will be for 2008,” he said. The agency posted a detailed report on the 2007 experience at its Web site last month (www.cms.hhs.gov/PQRI/Downloads/PQRI2007ReportExperience.pdf
Overall, there were submissions from 109,349 national provider identifier/tax identification numbers with at least one quality data code. Of those, about 93% (101,138) submitted at least one valid code. More than 14 million codes were reported; more than 50% of those (7.3 million) were validly submitted.
There were three major reasons for code nonvalidity: the provider did not adhere to the measure specification; the codes were not submitted with the same claim as the billing and diagnosis code submitted for the procedure; or there was no national provider number (NPI) on the claim.
Many of the submission errors were for patients who did not meet the reporting specifications regarding gender, age, or diagnosis or procedure code for a particular measure. For instance, the PQRI does not accept reports for diabetes measures on patients over age 75, said Dr. Rapp.
CMS plans to rerun reports for providers who did not qualify for the bonus, with the idea that mistakes could have been made and some providers could be found eligible for the bonus on reanalysis. If that is the case, the CMS will issue checks retroactively, he said.
The agency also aims to make some changes to reduce the number of rejected reports. It said it would continue conducting provider education and outreach to ensure physicians understand the specifications for reporting each measure.
The agency also is working with local Medicare carriers to ensure that when claims are split—where the quality codes are separated—they will be “reconnected and counted,” said the agency.
Claims that were submitted to carriers for payment in 2008 without an NPI were automatically rejected. As a result, in the first half of 2008, less than 1% of claims submitted were missing an NPI, said the report. The CMS expects less than 0.5% of PQRI claims to be without an NPI.
Physicians can qualify for the 2% PQRI bonus in 2009 in nine different ways, with an extra 2% for e-prescribing. DR. RAPP