Over the past several weeks I have received questions from some of our customers regarding the future of PQRI. As a bit of background, the Physician Quality Reporting Initiative (PQRI) has its origin in the 2006 Tax Relief and Health Care Act which required Health and Human Services to create a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries. The program began in 2007 and has evolved dramatically over the past few years with the addition of Measures Groups, Registry Reporting and an explosion in the number of quality measures available for reporting. PQRI is one component of CMS’s planned transition to value-based purchasing.
A number of nephrologists have participated in the PQRI program. Early participants met with substantial challenges, although more recently, the experience has improved with CMS recently reporting success rates for Registry reporting in excess of 95%. Nephrologists who successfully participated in 2009 can expect to receive their 2% incentive payment between October 25, 2010 and November 12, 2010. The incentive for successful participation in 2010 remains 2% and there is still time to report in 2010 through a qualified PQRI Registry. Our company has operated a nephrology-specific CMS-qualified PQRI Registry for the past two years.
What does the future hold for PQRI? The figure above contains information from the proposed 2011 Medicare Physician Fee Schedule (PFS). Note that the number of measures and measures groups increases in 2011; however, the incentive drops to 1%. Of interest to the nephrologist, measures number 79 and 135 (flu vaccine in ESRD and late stage CKD respectively) are being retired. On the bright side, this drops the number of individual measures in the CKD measures group to 4. Additionally, reporting thirty measures-group patients in 2011 will require that all thirty patients are Medicare part B beneficiaries (as opposed to 2010 when only 2 of the 30 patients must be part B beneficiaries). The proposed rule also describes the establishment of a “physician compare” website. Nephrologists need to pay close attention to these issues when the final rule is published next month.
Funding for PQRI has been extended through 2014 (table). As we have seen with the CMS e-Rx program, CMS has introduced the “stick” into the PQRI program. Providers not reporting PQRI in 2015 will see their Medicare fee schedule adjusted by 1.5%. The penalty rises to 2% in subsequent years.
One final point of clarification is the relationship between PQRI and meaningful use. Remember that the nephrologist may only participate in the CMS EHR incentive program (meaningful use) or in the CMS e-Rx incentive program, but not both. Those two programs are mutually exclusive. The opposite is true for PQRI. The nephrologist may participate in both the CMS EHR incentive program and PQRI during the same year. This means the nephrologist can expect to receive $18,000 for the Medicare EHR incentive program and 1% of their eligible Medicare part B charges if he/she successfully demonstrates meaningful use and reports PQRI in 2011. The PQRI measures are very similar to the Clinical Quality Measures the nephrologist will be expected to report for the CMS EHR incentive program. Next week I will explore this component of meaningful use.
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