But many physicians—including hospitalists—are not participating in PQRI.
“It comes down to different practice models,” explains Dr. Torcson. “But for many physicians, a major reason not to participate is that they’re taking a wait-and-see approach. They’re waiting to see if this is just the latest flavor of the month, and think it’s not worth investing time and effort until it proves otherwise.”
Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego (UCSD) School of Medicine, Division of Hospital Medicine, is a member of SHM’s Public Policy Committee and says he was disappointed his group is unable to participate in PQRI.
“I work for UCSD, where our hospitalist group is one of many, many subspecialty groups that work out of our hospital,” he explains “We do a lot of QI work, and we were certainly interested in participating in PQRI.” However, the hospital uses an electronic billing system incompatible with reporting on the measures. The software could be upgraded for about $15,000, says Dr. Seymann, but hospital administration sees no return on the investment.
“The cost wouldn’t match the increase in revenues because besides hospital medicine, there aren’t a lot of other subspecialties that would be interested in participating,” explains Dr. Seymann. “As much as I wanted our group to participate, I can’t fully fault UCSD on this decision on business grounds. They want to see some stability in [the decision to continue PQRI] before they invest.”
In the meantime, the orthopedics group at UCSD has invested in reporting. They are tracking PQRI measures on paper and reporting to CMS, and they’ll ultimately be able to show the administration whether the bonus per physician might add up to the cost of the necessary billing-system upgrade.
Beyond 2008
Everyone involved—not just UCSD—is asking: Is PQRI here to stay? That decision rests with federal lawmakers. At the end of this year, Congress must vote on whether to extend the program—and no one can guarantee whether that will happen.
“The chairs of the Senate Finance Committee have been tremendously supportive of the PQRI,” says Dr. Torcson. “There is a lot of political will behind this right now. [PQRI supporters in Congress] want better quality in healthcare for better pay.”
This year’s election will have a major impact on this decision: “A change in administration will definitely factor in,” warns Dr. Torcson. “The 2008 Medicare Physician Payment Update seemed to divide along party lines. Republicans were somewhat supportive, and Democrats didn’t seem to support it. It’s not quite that simple, but that was a general pattern.”
The best advice for physicians invested or interested in investing in PQRI is to keep an eye on the November election results and the Senate Finance Committee to find out what 2009 and beyond will look like for PQRI or other CMS pay-for-reporting initiatives.
Too Late to Participate?
Although the PQRI began Jan. 1, there is no enrollment process; physicians can start reporting any time during the year. However, participants reporting on three measures report in at least 80% of the instances in which those measures are reportable—that means all year—in order to qualify for a bonus. If you begin reporting this far into the year, you’re not likely to reach that threshold and earn your bonus.
“Starting late in the year could affect reaching that threshold, but it’s never too late to start the practice and process of reporting,” says Dr. Torcson. “You can still make that commitment to performance reporting. Even if you don’t get the 1.5% bonus, you get the benefit of getting started in the important practice of performance reporting.”