Medicare Quality Reporting

Published: Thursday, August 7, 2008 - 05:25

(CMS: Baltimore, Maryland) -- The Centers for Medicare and Medicaid (CMS) announced payment of more than $36 million in bonus payments to many of the more than 56,700 health professionals who satisfactorily reported quality information to Medicare under the 2007 Physician Quality Reporting Initiative (PQRI).

“Creating a value-based purchasing system is a critical way to improve our health care systems. By collecting quality data, health care providers can use the information to improve the quality care of beneficiaries,” says health and human services secretary Michael Leavitt.

Physicians, physician group practices, and other PQRI eligible professionals should receive their payments by August 2008. The average incentive amount for individual professionals is more than $600 and average incentive payment for a physician group practice is more than $4,700, with the largest payment to a physician group practice totaling more than $205,700.

“These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” says CMS acting administrator Kerry Weems. “We all can agree that the current payment system needs to be reformed to pay for high quality care rather than continuing to pay for the volume of services. The PQRI has proven to be a successful step towards establishing a value-based purchasing program for physicians.”

The PQRI is a voluntary program and, in accordance with a law passed by Congress late in 2006, physicians and other eligible professionals are able to receive bonus payments of 1.5 percent of their total allowed Medicare charges, subject to a cap, by satisfactorily submitting quality information for services they furnish between July and December of 2007. More than 109,000 professionals participated in the 2007. Of those, more than 56,700 physicians and other eligible professionals met statutory requirements for satisfactory reporting for the 2007 reporting period and are receiving incentive payments.

The 2007 reporting period received participation in all 50 states, including Washington D.C., Puerto Rico, Virgin Islands, and Guam. Of all the participating states and territories, health professionals in Florida and Illinois are receiving the highest incentive payments for the 2007 reporting period. In Florida, they will receive a total of more than $3 million and Illinois a total of more than $2 million.

While the 2007 PQRI was a positive step toward reporting quality information, the 2008 PQRI program included significant enhancements in terms of the scope of measures that could be reported, the opportunity to receive incentive payments for the entire year, ability to report measures within a group for a specified number of patients, and the use of registries to report quality measures.

All eligible professionals that participated in the 2007 PQRI can begin accessing confidential feedback reports that aggregates the data they submitted and shows them how they compare with other participants. Providers must register with the Individuals Authorized Access to CMS Computer Services—Provider Community (IACS-PC) to access the feedback reports.

The 2008 PQRI program has grown to include 119 quality measures that were published in the Physician Fee Schedule for 2008. Leading physician organizations participated in the development of the PQRI program measures. Nearly all of the measures are clinical performance measures, such as the percentage of patients who received necessary mammograms and cancer screenings. There are also two structural measures that focus on the use of electronic health records and electronic prescribing technology.

As an alternative to submitting 2008 PQRI quality data as part of their Medicare claims submissions, eligible professionals may choose to report data on quality measures through a medical registry, and these registries will then report that data to CMS. Registry-based reporting will provide another way for eligible professionals to qualify for an incentive payment. Participating eligible professionals who don’t report through a registry may choose to report data on either individual measures or on groups of measures that capture a number of data elements about common care processes for diabetes, kidney disease, and preventive medicine. Registry-based reporting and reporting on groups of measures will provide more ways for eligible professionals to quality for an incentive payment.

The PQRI is the first step toward bringing about changes in the way Medicare pays physicians and restoring stability and predictability to Medicare’s physician payment program. The current payment system has been acknowledged by many health care policy experts for its several failings, including rewarding volume and episodic care over quality; exposing Medicare to rapid growth in spending without evidence of more spending leading to better care; and failing to focus on prevention and coordination of care.

For more information, visit www.cms.hhs.gov/PQRI.

About The Author

Centers for Medicare and Medicaid Services

Formerly known as the Health Care Financing Administration, the Centers for Medicare and Medicaid Services are the federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance, Health Insurance Portability and Accountability Act, Clinical Laboratory Improvement Amendments, and several other health-related programs.