Pay-for-Reporting is Here to Stay
Congress made history in July when it passed legislation that makes Medicare’s voluntary pay-for-reporting program permanent.
The program, the Physician Quality Reporting Initiative, or PQRI, which began in 2007 as a six-month trial and was continued through 2008, rewards physicians who successfully report on specific applicable quality measures with a cash bonus. The new bill, the Medicare Improvement for Patients and Providers Act (MIPPA), extends the Centers for Medicare and Medicaid (CMS) program beyond 2010.
“PQRI is now a permanent program, even though the details have only been provided through 2010,” says Michael Rapp, MD, of the CMS Office of Clinical Standards and Quality.
Here, is a look at PQRI past, present, and future, from a hospitalist’s point of view.
Pay-for-Performance Pilot Proves Worthwhile
In August, CMS released statistics on that first pay-for-reporting period. During the trial, 101,138 physicians submitted a quality-data code. Of those, 70,207 reported on at least one measure, and 56,722 earned a bonus.
Asked about those numbers, Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., and chair of SHM’s Performance and Standards Committee, says: “I think the folks at Medicare were pleased with that level of participation. This data helped convince them that the program should be permanent.”
What to Expect in 2009
The PQRI for 2009 is subject to revisions until the 2009 Physician Fee Schedule Final Rule is published sometime around Nov. 1. (Find the latest information on CMS Web site at www.cms.hhs.gov/pqri.) A number of proposed enhancements make it attractive and important to physicians, Dr. Torcson says.
CMS proposed 175 quality measures for physicians to report on, and MIPPA boosts payment for successful reporting of data on those measures. For 2009 and 2010, physicians who participate in the PQRI can earn an incentive payment of 2% (up from 1.5%) of their total allowed charges for Physician Fee Schedule (PFS) covered professional services.
However, except for a bigger check from CMS, hospitalists who currently report may not see much difference next year. “Overall, for hospitalists, PQRI will look pretty similar to 2007 and 2008,” Dr. Torcson warns. “The bonus is going to increase and the measures will be the same. That means that all of the background and education that SHM has provided on PQRI reporting remains relevant.”
