Published 6/1/2008
Marty Krawczyk

CMS updates 2008 PQRI program

Recently, the Centers for Medicare and Medicaid Services (CMS) announced changes to the Physician Quality Reporting Initiative (PQRI), a claims-based voluntary pay-for-reporting program that began in 2007. These changes open the program to physicians who did not begin participating on Jan. 1, 2008, and provide for alternate reporting options.

The AAOS Web site (www.aaos.org/pqri) has complete information on how the PQRI currently works and the 13 measures that are generally applicable to orthopaedics this year. In 2008, physicians can report on 119 individual quality measures, of which 117 are clinical measures and 2 are structural measures. The structural measures apply broadly across specialties and document that the provider has adopted either a qualified electronic medical record or a qualified e-Prescribing system.

Two reporting methods can be used this year. The first is the “claims-based reporting” under which the provider reports individual measures for the entire year or reports on one of the four new “measure groups” (see below) developed by CMS on fee-for-service covered claims. The second reporting method is “registry-based data reporting.” Providers now have the option of reporting, via an approved registry, on either individual measures or one of the new “measure groups” (Fig. 1).

Claims-based reporting
Physicians participating for the full 2008 period (Jan. 1–Dec. 31) need to report on at least three PQRI measures for 80 percent of all applicable patient claims. (Physicians can report on one or two measures if there are not three measures applicable in their specialty.) Those physicians that report in accordance with the guidelines will be eligible for a bonus payment of 1.5 percent of their Medicare charges. In 2008, the incentive bonus payment is not capped.

An alternate reporting option is to report on one of four composite “measure groups.” These measure groups pull together nine individual quality measures for a single condition. In 2008, none of the four measure groups directly relates to care for orthopaedic patients, although CMS intends to expand the number of measure groups in future years.

The 2008 measure groups relate to diabetes mellitus, end-stage renal disease, chronic kidney disease, and preventive care. After selecting the appropriate measure group, physicians may report on 15 consecutive patients or they may select one measure group and report on 80 percent of the patients to whom that measure group applies.

Registry-based data reporting
CMS established technical and other requirements for registries to qualify to report PQRI data on behalf of physicians and other eligible professionals. Physicians must have documentation to demonstrate an established relationship with the registry and must attest to the validity of the data submitted to the registry. Orthopaedic surgeons will meet the criteria for reporting individual PQRI measures if they have been reporting measures through a registry since Jan. 1, 2008, or plan to report through a registry between July 1 and Dec. 31. Contact registries directly for more information. The names of the qualified registries will be posted on the CMS Web site by Aug. 31.

CMS has posted the requirements for registries to be eligible for PQRI at on its Web site (www.cms.hhs.gov).

2008 incentive bonus payments
Physicians can submit quality measures through both the claims-based submissions and through the registry-based data reporting method. Payment will be made on the longest reporting period under which the physician satisfactorily reports. The submission deadline for the 2008 bonus payment for both reporting methods is Feb. 28, 2009.

2007 incentive bonus payments
Physicians will have access to 2007 performance reports in mid-July. CMS will be forwarding PQRI payments from 2007 reporting to physicians in mid-July.

The AAOS will continue to work with CMS and Congress to ensure efficient implementation of the pay-for-reporting program, physicians input into the creation of the measures, and measures that reflect true quality care for patients.

Marty Krawczyk is the AAOS practice management program coordinator. She can be reached at krawczyk@aaos.org