CMS Reports Results of 2008 Medicare Physician Quality Reporting Initiative / CMS issues physician fee schedule final rule

Tue Nov 24 23:49:45 PST 2009

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November 13, 2009
CMS Reports Results of 2008 Medicare Physician Quality Reporting Initiative

The Centers for Medicare and Medicaid Services<http://www.cms.hhs.gov/default.asp?>

The Centers for Medicare & Medicaid Services (CMS) today announced the results for the 2008 Physician Quality Reporting Initiative (PQRI).  More than 85,000 physicians and other eligible professionals who satisfactorily reported quality-related data to Medicare under the 2008 PQRI received incentive payments totaling more than $92 million, compared to $36 million in 2007.
The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment.  In 2007, eligible professionals could only participate in the program during a 6-month reporting period.  In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.
Established in late 2006 by the Tax Relief and Health Care Act, the PQRI is a voluntary program that allows physicians and other eligible healthcare professionals to receive incentive payments for reporting data on quality measures related to services furnished to Medicare beneficiaries.  In the initial program years, physicians and other eligible professionals who satisfactorily submitted quality information for covered professional services furnished in the applicable reporting period were are able to receive incentive payments of 1.5 percent of the total estimated allowed charges under Medicare Part B for covered professional services.
Physicians and other eligible professionals who satisfactorily reported PQRI quality measures data and thus qualified for an incentive payment for the 2008 PQRI received their payments this fall.  The average incentive amount for individual professionals is over $1,000, with the largest payment to an individual eligible professional totaling over $98,000.
More than 162,800 professionals participated in the 2008 PQRI.  Of those, over 85,000 physicians and other eligible professionals met statutory requirements for satisfactory reporting for the 2008 reporting period and are receiving incentive payments.
>From the 2007 to the 2008 PQRI program year, CMS added several new features to make it easier for healthcare professionals to participate, including expanding the number of measures from 74 in 2007 to 119 in 2008.  Leading physician organizations and health care quality organizations participated in developing these measures.  Nearly all of the measures are clinical performance measures, such as the percentage of patients who received necessary mammograms and cancer screenings. In 2008, CMS also added two structural measures that focus on the use of electronic health records and electronic prescribing technology.
Also, for the first time in 2008, eligible professionals had the choice to report data on quality measures through a qualified medical registry, which then reported that data to CMS.  These 31 registries are third-party databases that many professionals were already using to report data to researchers about common care processes for diabetes, kidney disease, and preventive medicine.  Nearly 8 percent of PQRI participants in 2008 attempted to send their data to CMS via a registry.  Of those eligible professionals, nearly 96 percent met the requirements for satisfactory reporting and qualified for an incentive payment, accounting for 17 percent of the overall payments made for the 2008 program year.
Eligible professionals from all U.S. states and territories participated in PQRI in 2008.  Health practices with participating eligible professionals in Florida and Illinois received the highest incentive payments for the 2008 PQRI.  In Florida, eligible professionals received a total of over $7.5 million, and in Illinois, they received over $6 million.
CMS also announced that a number of health professionals who reported in 2007 will receive incentive payments as a result of a re-run of data the agency used to make its initial 2007 PQRI incentive payment determinations.  The re-run was based on a report CMS issued in late 2008 that identified several data issues in the initial 2007 analysis.  CMS modified its analysis process to resolve the data issues and has identified over 3,900 additional eligible professionals to receive PQRI incentive payments for the 2007 PQRI.  These payments averaged over $860 per eligible professional.  Practices associated with these eligible professionals will receive 2007 incentive payments from their Medicare Administrative Contractors (MACs) in November 2009.
Eligible professionals who participated in the 2008 PQRI can access confidential feedback reports that aggregate the data they submitted across all practices with which they are associated.  The reports also show eligible professionals how they compare with other participants across the country who have submitted the same measures.  CMS redesigned these reports for 2008 based on feedback from national stakeholder focus groups.  Features in the new report include additional data formats and more information about reporting and performance rates per measure.
Providers can access their confidential feedback reports at the Tax Identification Number (TIN) level, beginning October 30, 2009, by visiting the secure PQRI portal at http://www.qualitynet.org/pqri.  Trained Help Desk staff will assist providers with accessing their feedback reports at 1-866-288-8912 or at Qnetsupport at sdps.org.  Support is available on Monday through Friday from 7:00 a.m. to 7:00 p.m. Central Time.  In addition, individual professionals can access their feedback reports by contacting their Part A/Part B MAC at its Provider Contact Center.
Congress extended the PQRI in 2008 and authorized incentive payments through 2010.  While the 2008 PQRI program included positive changes to ease the reporting of quality measures, the 2009 PQRI program provides enhancements that will make it even easier for physicians and other health care professionals to participate.  Beginning in 2009, Congress increased the incentive that eligible professionals could receive for satisfactorily reporting data from 1.5 percent to 2.0 percent of the estimated allowed charges under Medicare Part B for all such covered professional services for the applicable reporting period for 2009 and 2010.
CMS added 52 new quality measures for the 2009 PQRI year, raising the total number of measures to 153.  These new measures cover all types of healthcare professionals who provide services to Medicare beneficiaries, and address areas such as osteoarthritis, back pain, coronary artery disease, and HIV/AIDS, as well as 18 measures that must reported exclusively through PQRI-qualified registries.
CMS recently announced its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule.  A fact sheet on the 2010 PQRI Program is available online at http://www.cms.hhs.gov/apps/media/press/factsheet.aspCounter=3541&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.<http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3541&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date>
 A press release on the 2008 PQRI results may be viewed at http://www.cms.hhs.gov/apps/media/press_releases.asp.
More information about the PQRI program, including how eligible professionals can participate and the criteria to qualify for an incentive payment is available at www.cms.hhs.gov/PQRI.
November 2, 2009
CMS issues physician fee schedule final rule
The American Hospital Association<http://www.aha.org/>
The Centers for Medicare & Medicaid Services late Friday released the Medicare physician fee schedule final rule<http://www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf> for calendar year 2010, which will cut Medicare payment rates for physicians by 21.2%, unless Congress acts to prevent it. The rule adopts CMS' proposal to remove physician-administered drugs from the annual payment update formula, which the agency projects will raise the payment update in future years. The House of Representatives recently introduced the Medicare Physician Payment Reform Act (H.R. 3961), which would permanently reform Medicare's physician payment formula. The Senate last month failed to advance a bill halting the physician pay cut, with opponents arguing the bill would have added to the federal deficit.

Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine
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