The Physician Quality Reporting Initiative
(PQRI)HistoryThe 2006 Tax Relief and Health Care Act
(TRHCA) required the establishment of a physician quality reporting
system, including an incentive payment for eligible professionals who
satisfactorily report data on quality measures for covered services
furnished to Medicare beneficiaries during the second half of 2007 (the
2007 reporting period). CMS named this program the Physician Quality
Reporting Initiative (PQRI). CMS initially launched the PQRI on
July 1, 2007. The voluntary reporting program offered physicians an
opportunity to receive bonus payments of up to 1.5% of Medicare charges
by reporting quality measures on claims for services from July 1 to
December 31, 2007. The Medicare, Medicaid, and SCHIP Extension Act
of 2007 (MMSEA) was enacted on December 29, 2007 and authorized CMS to
make PQRI incentive payments for satisfactorily reporting quality
measures data in 2008. For 2008, eligible professionals who met the
criteria for satisfactory submission of quality measures data for
services furnished during the reporting period (January 1, 2008 through
December 31, 2008) earned an incentive payment of 1.5% of their total
allowed charges for Physician Fee Schedule (PFS) covered professional
services furnished during that same period. MMSEA also provided
professionals greater flexibility for participating in the PQRI for
2008, by authorizing CMS to establish alternative reporting criteria and
alternative reporting periods for the reporting of measures groups and
for the submission of data on PQRI quality measures through clinical
data registries. The Medicare Improvements for Patients and
Providers Act (MIPPA), passed in July 2008, contained several new
authorities and requirements for the PQRI. Through the MIPPA
legislation, Congress made the PQRI a permanent program and raised the
incentive payment for successfully reporting quality measures to CMS.
For 2009 and 2010, physicians who successfully participate in the PQRI
can earn an incentive payment of 2.0 percent (up from 1.5 percent) of
their total allowed charges for PFS covered professional services. MIPPA
also directs CMS to post on its website the list of providers who
satisfactorily participate in the PQRI. Beginning in 2009, and
during the next four years, Medicare will also provide incentive
payments to eligible professionals who are successful electronic
prescribers. Eligible professionals will receive a 2 percent incentive
payment in 2009 and 2010; a 1 percent incentive payment in 2011 and
2012; and a one half percent incentive payment in 2013. Beginning in
2012, eligible professionals who are not successful electronic
prescribers will receive a reduction in payment. Financial
incentives earned for reporting are paid for from the Federal
Supplementary Medical Insurance (Part B) Trust
Fund. NewsCMS to Distribute 2009 Incentive
Payments Starting Oct 25
CMS will distribute 2009 PQRI
incentive payments to successful participants between Oct. 25 and Nov.
12, 2010. The 2009 PQRI feedback reports will be available on the
Physician and Other Health Care Professionals Quality Reporting Portal
at http://www.qualitynet.org/pqri starting the second
week of November. Participants may also contact their Carrier/MAC to
request individual NPI-level reports at http://www.cms.gov/MLNMattersArticles/downloads/SE0922.pdf. ACCP
Releases PQRIWizard for Community-Acquired Pneumonia Measure Group
Register now for PQRIwizardSM, a new online reimbursement
tool for quickly and effectively collecting, validating, and reporting
quality measure data for the CMS PQRI incentive payment program. Use the
PQRIwizard for the community-acquired pneumonia (CAP) measure group to:
optimize your PQRI incentive, minimize data entry time (requires as few
as 30 consecutive patient records), and eliminate claims and coding.
Find out more about registering
here CMS Releases 2010 Measure Specifications
On December 14, CMS announced the release of 2010
e-prescribing and PQRI measure specifications as well as information
regarding 2010 PQRI reporting periods and options. SHM members
interested in participating in the PQRI next year are urged to review
this information to identify applicable quality measures for
reporting. Six measures remain available for registry or
claims-based reporting by hospitalists, including: #6 Antiplatelet
Therapy for CAD, #31 Stroke VTE Prophylaxis, #32 Stroke Antiplatelet
Therapy, #35 Stroke Dysphagia Screening, #36 Stroke Rehab Eval, and #47
Advance Care Planning.
For more information visit the CMS PQRI
website CMS Announces Qualified Registries for
2010 PQRI Reporting
CMS is pleased to announce the
registries that have become “qualified” to submit quality
data to CMS on behalf of their eligible professionals for 2010 PQRI
reporting. Each of these registries has gone through a thorough
vetting process including checking their capability to provide the
required PQRI data elements, reviewing a measure flow, and transmitting
the required information in the requested file format.
See the list of approved
registries CMS Reports Results of 2008 Medicare
Physician Quality Reporting Initiative
November 13, 2009: 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.
View the full release here SHM's
InvolvementSHM's Public Policy Committee has commented on the
PQRI proposals outlined in the pending health reform bills. See comment
letters below. SHM Provides Comments in Response to Feb 2 CMS Listening
Session on PQRI
SHM's Recommendations for Promoting Quality Improvement
in Health Reform
SHM Comments on FY 2010 Medicare Proposed Physician
Payment Rule - August 28, 2009
SHM Comments on H.R. 3200, "America's Affordable Health
Choices Act" - July 17, 2009
SHM Comments on House Tri-Committee Discussion Draft on
Health Reform - July 9, 2009
SHM Comments on HELP Committee Reform Bill - July 6,
2009
SHM Comments on Senate Finance Committee Policy Options
on Delivery System Reform - May 15, 2009 Educational
ResourcesQualified Registries for the 2010 PQRI and
Electronic Prescribing Incentive Programs
CMS is pleased
to announce the registries that have become "qualified" to
submit quality data to CMS on behalf of their eligible professionals for
2010 PQRI reporting. February 2, 2010, PQRI Listening
Session:
CMS hosted a Listening Session on the 2011 PQRI.
The purpose of this listening session was to discuss and solicit
feedback on the individual quality measures and measures groups being
considered for possible inclusion in the proposed set of quality
measures for use in the 2011 PQRI program and key components of the
design of the PQRI program, such as possible reporting mechanisms,
reporting periods, criteria for satisfactory reporting, the group
practice reporting option, and public reporting of 2011 PQRI data.
Download the session materials here:
Listening Session Background Paper
Listening Session Presentation
SHM Comments – Dr Pat Torcson, Performance &
Standards Committee Chair PQRI Update: 2008 Data and
2010 Program Changes
View the Dec 7 presentation from CMS Director, Quality
Measurement & Health Assessment Group Michael Rapp, MD,
JD Registry Requirements For Submission Of 2010 PQRI
Data On Behalf Of Eligible Professionals
Eligible professionals whose 2010 PQRI quality measure information is
successfully submitted by a registry and satisfies the applicable
criteria for satisfactorily reporting for the January-December
(full-year) reporting period OR the July-December (half-year) reporting
period may earn an incentive payment equal to 2.0 percent of their total
allowed charges for MPFS covered professional services furnished during
the applicable 2010 reporting period.
http://www.cms.hhs.gov/PQRI/Downloads/2010RegistryRequirementsFinal_1.pdf The
Physician's Quality Reporting Initiative (PQRI): Getting your
Hospitalist Program Started in Medicare's Voluntary Pay for Reporting
Program
SHM hosted the first ever Practice Administrators' Roundtable Series
with a presentation from Dr. Pat Torcson on the PQRI.
Click here to view the full presentation
Access 2007 Re-Run and 2008 PQRI Feedback
Reports
CMS has posted two educational guides on understanding the PQRI
incentive payments for the 2007 re-run and for 2008.
A Guide for Understanding the 2007 Re-Run PQRI Incentive
Payment
A Guide for Understanding the 2008 PQRI Incentive
Payment Medicare Learning Network Announces New and
Revised MLN Articles on the 2009 PQR
These new and revised articles are intended to assist eligible
professionals and group practices who report PQRI quality measures data
to Medicare. New - Coding and Reporting Principles for the Physician
Quality Reporting Initiative (PQRI) and the Electronic Prescribing
(E-Prescribing) Incentive Programs
Steps for Individual Eligible Professionals to Access
Their 2007 Physician Quality Reporting Initiative (PQRI) Feedback
Reports Personally
Steps for Organizations to Access Their 2007 Physician
Quality Reporting Initiative (PQRI) Feedback
Reports CMS is pleased to announce three PQRI Help Desk Resources to assist eligible professionals
with their questions:
Provider Call Center Directory
External User Services (EUS)
QualityNet Help Desk Understanding the PQRI Program - An
Article from Modern Physician
Read the April 13, 2009 article from Cynthia Dunn
Tools for Individual Measures and Measures
Groups
The American Medical Association has created participation tools to
assist physicians and other eligible professionals who have elected to
participate in the PQRI program for 2009. These tools for the
claims-based reporting of individual quality measures and measures
groups are designed to facilitate the data collection required to report
clinical performance data. These tools can be accessed online by
clicking here. Satisfactorily Reporting 2009
PQRI Measures
Click here to review the tip
sheet 2009 Final Measure Specifications
Released
Click here to find out more CMS
Overview
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