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What is Medicare’s Physician Quality Reporting Initiative?
How long is the 2009 PQRI reporting period?
Is participation in PQRI mandatory as a condition
of payment under Medicare?
What is the incentive for physicians to participate
in PQRI?
How do I register to participate in the program?
Who is eligible to participate in the program?
What measures are available for cardiologists
to report in 2009?
Are there changes to the cardiology measures
between 2008 and 2009?
Will the PQRI worksheet be updated to include
the 2009 changes?
What are the reporting requirements?
What should I do right now?
Who can I contact for help at the ACC?
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Q1: What is Medicare’s Physician
Quality Reporting Initiative?
A: The “Physicians Quality Reporting Initiative”
(PQRI), was formerly known as the “Physician Voluntary
Reporting Program (PVRP). In December 2006, President Bush
signed the Tax Relief and Health Care Act of 2006, mandating
establishment of a physician quality reporting system and
authorizing a payment incentive for voluntary participation.
Q2: How long is the 2009 PQRI reporting
period?
A: The 2009 reporting period is from January 1 through December
31, 2009.
Q3: Is participation in PQRI mandatory
as a condition of payment under Medicare?
A: Participation in PQRI continues to be strictly voluntary.
Q4: What is the incentive for physicians
to participate in PQRI?
A: Physicians who successfully report quality measures for
care delivered to Medicare beneficiaries January 1-December
31, 2009 are eligible to receive a bonus payment of 2% of
total allowed charges for covered services payable under the
Medicare Physician Fee Schedule.
Q5: How do I register to participate
in the program?
A: Registration is not necessary. However, those who decide
to participate in the program must begin reporting the appropriate
quality measure data on claims submitted to their Medicare
claims processing contractor on January 1, 2009.
Analysis is expected to be performed at the individual physician
level; therefore accurate and consistent use of individual
National Provider Identifier (NPI) on claims is required.
Q6: Who is eligible to participate
in the program?
A: All Medicare-enrolled eligible professionals may participate,
regardless of whether they have signed a Medicare participation
agreement to accept assignment on all claims. Eligible professionals
include physicians and other practitioners described in Social
Security Act (SSA) Section 1861(r) and Section 1842(b)(18)(C)
who provide professional services that get paid under the
Medicare Physician Fee Schedule (MFS). Services which are
paid under the MFS are eligible for the incentive payment.
For a complete list of eligible professionals, check the CMS
website.
Q7: What measures are available for
cardiologists to report in 2009?
A: Five of the 15 measures from the ACC starter set for cardiology
are eligible for claims-based reporting among the 153 measures
for 2009 . The ACC is asking cardiologists to report on these
Physician Consortium for Performance Improvement (PCPI), National
Quality Forum (NQF)-endorsed measures, which include at this
time:
- Measure 5: ACE or ARB therapy for heart failure patients
with LVSD
- Measure 6: Antiplatelet therapy prescribed for CAD patients
- Measure 8: Beta-blocker therapy prescribed for heart
failure patients with LVSD
- Measure 118: ACE/ARB Therapy for Coronary Artery Disease
and Diabetes and/or LVSD
- Measure 152: Lipid Profile in patients with CAD
All 153 measures and their technical specifications were
posted on December 15, 2008 and are available on the CMS website
and the ACC website.
Q8: Are there changes to the cardiology
measures between 2008 and 2009?
Measure 7: Beta blocker for CAD patients with prior myocardial
infarction is the only cardiology measure with significant
changes from 2008. It is no longer eligible for claims-based
reporting. It is only reportable via a registry option.
Q9: Will the PQRI worksheet be updated
to include the 2009 changes?
Yes, the ACC updated its worksheet for use by cardiology
practices to help with data collection. It is posted on the
ACC website.
Q10: What are the reporting requirements?
A: To be eligible for the incentive payment, an eligible
professional must report on at least three quality measures.
For each of the three measures, reporting must occur on at
least 80 percent of the cases for which that measure is reportable.
Each of the cardiology measures is to be reported a minimum
of once per reporting period for all eligible patients seen
during the reporting period. If it is determined that reporting
occurred less than 80 percent of the time for any one of the
measures, the professional would be ineligible for the incentive
payment.
Q11: What should I do right now?
A. Bookmark the link: http://www.cms.hhs.gov/pqri/
. Check it often.
Understand the measures.
Educate staff.
Q12: Who can I contact for help
at the ACC?
A. Eileen Hagan, Associate Director, Payer Advocacy
800-253-4636, ext 6475 or ehagan@acc.org |
