Medicare physician quality reporting initiative everything you need to know
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Medicare Physician Quality Reporting Initiative: Everything You Need to Know. March 4, 2009. Webinar Overview . Welcome and webinar housekeeping issues CMS Physician Quality Reporting Initiative (PQRI) presentation Description of 2009 PQRI program

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Presentation Transcript

Webinar overview
Webinar Overview You Need to Know

  • Welcome and webinar housekeeping issues

  • CMS Physician Quality Reporting Initiative (PQRI) presentation

    • Description of 2009 PQRI program

    • Experience, lessons learned from 2007 and 2008 programs

  • ACP presentation of guidance, resources, and member experience

  • Question and answer period

Acp pqri guidance resources
ACP PQRI Guidance/Resources You Need to Know

  • If have you are already reporting on three individual quality measures through claims in 2009, continue to do so

  • It’s not to late to start reporting individual quality measures and hit the 80% threshold of eligible cases

  • Over 30 measures common to internal medicine practice need to be reported only once in the 12 month reporting period, including: diabetes; coronary heart disease; and some geriatrics measures

  • Could pick three diabetes measures, e.g. Hb A1c, LDL, blood pressure, or three screening measures, e.g. flu vaccine, pneumonia vaccine, and tobacco use inquiry

Individual measure reporting
Individual Measure Reporting You Need to Know

  • Assess whether patients eligible for selected measures have been seen in the office in the first six months of year/are likely to be seen in second half of the year

  • Coding tool resources available

    • ACP coding tool template with seven measures common to general internal medicine available at

    • CMS/AMA measure-specific “PQRI Data Collection Worksheets” are available at

Measures groups guidance resources
Measures Groups Guidance/Resources You Need to Know

  • Provides a potentially more straightforward reporting method

  • Ability to successfully report 80% over time enables you to earn bonus if you miss a consecutive patient

  • Diabetes Mellitus and Preventive Care measures group are most relevant to IM practice

  • Uniformity of denominator criteria—age, diagnosis, and office encounter—make diabetes measures group an attractive option

  • ACP coding tool for diabetes measures group at

Measures groups guidance resources1
Measures Groups Guidance/Resources You Need to Know

  • AMA Preventive Care measures group data collection sheet at

  • AMA participation tools for each measure group--description and data collection sheet—at

Registry reporting guidance resources
Registry Reporting Guidance/Resources You Need to Know

  • Can be used to reporting individual quality measures or measures groups; over 12 month or six month period

  • 32 CMS-selected registries currently participate

  • ACP provides information on registry options at

    • Includes information obtained directly from registries most relevant to internists

  • CMS to announce additional eligible registries by July 31, 2009

Acp member experience
ACP Member Experience You Need to Know

  • CMS reports that early internist participation similar to average all-physician participation level

  • ACP survey shows that less than 20% members participated, with those in 6-20 physician practice most likely

  • Internist report challenges and frustration, including: inability to know if participating “correctly”; not receiving a bonus thought to be earned; receiving a bonus payment amount less than expected; and problems accessing reporting/performance feedback report

  • ACP is challenged to reach those not participating/help those participating

Cms program adjustments
CMS Program Adjustments You Need to Know

  • Now uniformly used NPI to improve physician attribution

    • More accurate reporting/performance scores

    • More accurate bonus payments

  • No longer need to code precisely by “pointing” diagnosis code to quality code(s)—CMS re-running analysis for 2007 and 2008, likely to result in more earning bonus

  • Agency committed to making it easier to access reporting/performance report

    • May be as straightforward as agency e-mailing report to participating physician

Conclusion You Need to Know

  • Additional PQRI improvements are needed, such as providing more timely feedback

  • ACP appreciates CMS outreach and openness to suggested improvements

  • Worthwhile for internists to participate, especially because likely to remain component of Medicare payment system

  • Think of all Medicare bonus payment opportunities collectively—and how to efficiently earn them

  • ACP Medicare e-prescribing incentive payment resources at

Thank you
Thank You Need to KnowYou

Question and Answer Period

ACP Contact for questions/more information:

Brett BakerDirector, Regulatory and Insurer Affairs Division of Governmental Affairs & Public [email protected]