The Centers for Medicare & Medicaid Services will offer a variety of new reporting options to encourage physicians to submit quality data.
The Physician Quality Reporting Initiative allows the use of 119 measures, including two "structural measures" focusing on the use of electronic health records and electronic prescribing technology.
The other 117 measures are clinical performance measures, developed by leading physician organizations. These measures include factors such as the percentage of patients who are receiving cancer screenings and flu shots.
Congress made changes to the PQRI program with the passage of the Medicare, Medicaid and SCHIP Extension Act of 2007. The statute requires the Department of Health and Human Services to establish alternative criteria for submitting quality information.
For 2008, in addition to submitting PQRI measure data as part of their Medicare claims submissions, eligible professionals may report data on quality measures to a medical registry, which then can report the data to CMS.
"By providing more opportunities to submit information about the quality of care provided to Medicare beneficiaries, we will ultimately improve the services provided to our beneficiaries," said CMS Acting Administrator Kerry Weems. "The Physician Quality Reporting Initiative puts an emphasis on measuring and improving the performance of the healthcare system to reduce inappropriate care and encourage best practices in care."
In addition to providing new flexibility for submitting data, registry-based reporting will provide more ways for eligible professionals to qualify for an incentive payment. They can choose to report data on either individual measures or on groups of measures that capture a number of data elements about common care processes for diabetes, kidney disease and preventive medicine.
Another change under the enhanced PQRI program for 2008 will be new PQRI reporting periods for eligible professionals who report using measures groups. Participants now may start reporting in July and still be eligible to earn an incentive payment for the 2008 PQRI program. Details about how an eligible professional can qualify for an incentive payment under this new option are available at www.cms.hhs.gov/PQRI.
Implemented in 2007, the PQRI creates a quality reporting system that includes an incentive payment for satisfactorily reporting data on quality measures for covered professional services delivered to Medicare beneficiaries.
Under the 2007 PQRI, providers who satisfactorily report data on quality measures for covered professional services provided during the second half of 2007 will receive an incentive payment this year, capped at 1.5 percent of their total allowed charges for covered services during the reporting period.
Preliminary participation data indicates that more than 100,000 eligible professionals submitted quality measure data related to PQRI at least once in 2007, and CMS said participation rates have continued to increase over time. CMS believes that more than half of the eligible professionals who participated in PQRI in 2007 appear to be on track to receive an incentive payment.