PQRI Physician Quality Reporting Initiative: an OverviewMarch 5th, 2009 - Betsy Nicoletti
PQRI The briefest of historical reviews
2007: 1.5% potential payment with cap on total payment
• Half year reporting period
• Bonus payment subject to cap
• 1.5% of total allowed Medicare Fee Schedule payments
• Includes Railroad Retirement Board charges
• Excluded are labs (not paid under MFS) and any claims submitted to Part A Fiscal Intermediary, such as Rural Health Claims, FQHCs
• Excluded are drugs, drug administration charges are included
• Excluded HPSA bonuses
• Claims based
• 74 measures
• Low participation rate, lower success rate, difficulty in accessing reports
2008: 2% potential payment
• Full and half year reporting allowed, bonus based on charges during reporting period
• Eliminated cap on incentive payment
• Allowed for alternative reporting options, including registry and measures group reporting
• Allowed for claims based and consecutive patient reporting
• Total of 9 PQRI Reporting methods, 3 claims based, 6 registry based
PQRI for 2009
• Still voluntary for 2009
• 2% potential bonus of allowed Physician Fee Schedule charges (same definition of allowed charges as 2007, 2008)
• No need to register to participate
• Report options: claims based, Registry, Measures groups
• Report using “Quality Data Code” QDC. These are either HCPCS codes or CPT® II codes. Some measures have modifiers as well
• Must report on at least 3 measures for 80% of the applicable cases
• If only one or two measure applicable, then report on these 80% of time
• If only one or two measures, look again at the measures that apply to many providers, any specialty
Which is an example of successful reporting?
Reporting 80.5% of the time on 3 measures?
Reporting 79.9% of the time on 10 measures?
The first! So, concentrate on 3 measures.
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