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1. Physician Quality Reporting Initiative (PQRI) Measures
2. What is PQRI?
The 2006 Tax Relief and Health Care Act (TRHCA) required the establishment of a physician quality reporting system.
Reauthorized in 2007, permanent in 2008
Incentive payment for voluntarily reported data on quality measures
3. What is PQRI? The goals of this program were to:
Improve the quality of healthcare for Medicare recipients
Transition the Centers for Medicare and Medicaid Services (CMS) towards becoming an “active” rather than “passive” payer in an attempt to control costs.
4. What is PQRI? Currently, incentives are paid for simply reporting on designated quality measures.
It is anticipated that PQRI will be transitioned to a “pay for performance” model.
5. What Quality Measures are Included? The 2009 PQRI measure list identifies 153 quality measures and 7 measure groups.
Nine are considered to be “emergency medicine” measures.
6. What Quality Measures are Included? # 28 ASA at arrival for acute myocardial infarction
#31 DVT Prophylaxis for ischemic stroke or intracranial hemorrhage
#34 TPA considered for ischemic stroke
#54 12 lead ECG for non traumatic chest pain
7. What Quality Measure Are Included? # 55 12 lead ECG for syncope
#56 Vital signs reviewed for community acquired pneumonia (CAP)
#57 Assessment of oxygen saturation in CAP
#58 Assessment of mental status in CAP
#59 Initiation of antibiotics in CAP
8. Who Chooses These Quality Measures? Multiple public / private groups involved
Any entity may suggest a PQRI measure
Majority have been by the AMA PCPI (Physician Consortium for Performance Improvement)
ACEP is a member of PCPI
9. How Does PQRI Work? Providers are eligible by choosing three measures to report.
The measures are then reported to CMS
If a reporting rate of at least 80% is provided, providers receive a bonus payment of 2%.
10. Are There Problems Associated with PQRI? The underlying assumption of this program is that physicians will change their practice based on financial incentives.
These changes in practice are then anticipated to improve the quality of healthcare and reduce overall costs.
11. What Concerns about PQRI Exist? Quality measures are not always easy to report and may reflect patient compliance instead of only physician performance.
Some of the PQRI measures may not be based on current evidence based medicine.
12. What Concerns about PQRI Exist? There is a new movement to include process measures such as door to physician and door to discharge times which would not be practical in many ED’s.
Quality measures can threaten physician autonomy by pressuring physicians to complete measures which may not be the best course for an individual patient.
13. What Concerns About PQRI Exist? Quality measure performance could be made available to the public which could be misleading to patients in regards to a physician’s quality.
14. Why Should EM Residents Care? The move towards a pay for performance system appears inevitable.
The transition to a new payment structure will have an impact on emergency medicine in both payment and professional practice.
As new physicians enter into practice, they will be most affected by these new measures.
15. Why Should EM Residents Care? Current residents are in the unique position to influence the structure of a future payment system and policy decisions.
A passive approach will lead to the development of policy by lawyers and politicians which could be detrimental to the practice of medicine and patient care.
16. References Centers for Medicare and Medicaid Services: www.cms.hhs.gov/PQRI
American College of Emergency Physicians FAQS on PQRI: http://www.acep.org/practres.aspx?LinkIdentifier=id&id=30492&fid=2294&Mo=No&taxid=117956
EMRA Emergency Medicine Advocacy Handbook
