Published 1/1/2008
Robert H. Haralson, MD, MBA

PQRI in 2008: More measures, still voluntary

CMS renews the Physician Quality Reporting Initiative

As most physicians know, the Center for Medicare and Medicaid Services (CMS) has renewed the Physician Quality Reporting Initiative (PQRI) for 2008. The specifications for the 2008 program are similar to those for the 2007 program. The program remains voluntary and will include all of 2008.

As under the previous program, participating physicians are eligible to be reimbursed 1.5 percent of their total Medicare billings if they report at least three measures for at least 80 percent of their eligible patients. Four measures that might be applicable to orthopaedic surgeons have been added; one measure applicable to orthopaedic surgery in the 2007 program has been deleted for 2008. The deleted measure provided for counseling on the use of vitamin D and exercise for the prevention of osteoporosis.

New measures for 2008
CMS has added the following new measures for 2008:

  • Health information technology adoption (#124)—Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted a qualified electronic medical record (EMR), defined as one certified by the Commission for Healthcare Information Technology or capable of all of the following: Generating a medication list, generating a problem list, and entering laboratory tests as discrete searchable data elements.
  • Use of e-prescribing (#125)—Documents whether provider has adopted a qualified e-prescribing system and the extent of its use in the ambulatory setting. To qualify, the system must be capable of all of the following: Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s), if available; selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks (defined below); providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any); providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan.
  • Diabetic foot and ankle care, peripheral neuropathy: neurological evaluation (#126)—Percentage of patients age 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities.
  • Diabetic foot and ankle care, ulcer prevention: the evaluation of footwear (#127)—Percentage of patients age 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing.

The foot measures were developed by podiatric surgeons but can be used by any physician.

Other measures may apply
The following measures might be applicable to orthopaedic surgeons in unusual circumstances:

  • Medication reconciliation (#46)—Percentage of patients age 65 years and older discharged from any inpatient facility (eg, hospital, skilled nursing facility, or rehabilitation facility) and seen in the office within 60 days following discharge by the physician providing ongoing care. The physician will have had a reconciliation of the discharge medications with the current medication list in the medical record
  • documented.
  • Disease-modifying antirheumatic drug (DMARD) therapy in rheumatoid arthritis (#108)—Percentage of patients age 18 years and older who were diagnosed with rheumatoid arthritis and were prescribed, dispensed, or administered at least one ambulatory prescription for a DMARD.
  • Inquiry regarding tobacco use (#114)—Percentage of patients age 18 years or older who were queried about tobacco use one or more times within 24 months.
  • Advising smokers to quit (#115)—Percentage of patients age 18 years and older who are smokers and who received advice to quit smoking.

For more information
The technical specifications can be viewed on the CMS Web site (
www.cms.hhs.gov). Click on PQRI, go to Downloads, and click on the 2008 PQRI measure specifications.

The AAOS Web site (www.aaos.org/pqri) has condensed versions of the measure specifications for the most common measures utilized by orthopaedic surgeons and a detailed description of how to participate in the PQRI program.

AAOS suggests that orthopaedic surgeons consider participating in the 2008 PQRI program. The program offers physicians an opportunity to increase their incomes to some degree with very little effort. In addition, because quality reporting will likely become mandatory in the future, participation in the voluntary program provides a chance to learn how to report quality data without penalty.

Robert H. Haralson, MD, MBA, is AAOS director of medical affairs. He can be reached at haralson@aaos.org