Advocacy and policy news for internists

PQRI: What to Expect in 2009

HealthDay News -- The U.S. government's Centers for Medicare & Medicaid Services (CMS) is upping the ante for doctors who participate in Medicare's Physician Quality Reporting Initiative in 2009 by adding 52 new quality measures and boosting bonus payments a half percentage point to 2 percent.

But will it be enough to woo doctors to a program they've found cumbersome?

"I think what you're hearing from rank-and-file members, for good reason, is that CMS went about the execution of this program probably in the worst way possible if you want to get people to buy into the concept of performance-measurement reporting," said Bob Doherty, the ACP's senior vice president of governmental affairs and public policy.

What's lacking, he said, is regular feedback to physicians and some predictability that good-faith efforts to report on certain metrics will be rewarded.

ACP has been communicating with CMS to ensure a more effective program. For now, he said, internists will have to weigh the investment, resources and continued frustrations they may encounter against the additional revenue to the practice.

"Ultimately it's an individual practice decision to make," agreed Robert Bennett, government affairs representative in the Washington, D.C., office of the Medical Group Management Association (MGMA), an umbrella organization representing about 13,500 group medical practices.

MGMA is also working with CMS to improve the program, but "right now, there's a very far disconnect between the PQRI and anything that actually does change provider behavior to increase and improve quality," Bennett said.

PQRI is a voluntary quality-reporting program established to reward doctors for high- quality care. In 2009, eligible professionals may select from 153 measures in seven groups on which to report. Depending on the reporting method used and the reporting period selected -- January to December or July to December -- physicians must report on one to three individual measures or all measures in a group for 80 percent of applicable Medicare cases.

PQRI "an important first step" in Medicare's commitment to so-called "value-based purchasing" or "pay-for-performance," Dr. Thomas Valuck, a medical officer and senior adviser to CMS, said in an October 2007 commentary in Current Clinical Practice. He noted that the program supports physicians by enhancing professionalism through accountability, providing feedback for performance improvement and encouraging investment in the future of the practice.

It's a "very good goal" and one the CMS is striving to attain, said Tracey Glenn, director of practice management consulting at PMSCO Healthcare Consulting, a subsidiary of the Pennsylvania Medical Society, "but I don't think the program is honed yet to be able to do these things."

In September, MGMA released results of a practice leader survey indicating widespread frustration with program. Nearly 93 percent of respondents had trouble accessing reports from CMS, and nearly 70 percent reported "no" or "low" satisfaction with the guidance provided on improving patient outcomes. More than a third (37.5 percent) said participating in the program increased their support staff expenses.

Lag times also remain a problem. Physicians who participated in PQRI's first round, begun in July 2007, didn't receive payment or feedback until July 2008, Glenn said. CMS said it paid more than $36 million in bonuses to 56,700 health professionals.

Physicians who participated in the 2008 program, begun in January, may not receive payment or feedback until July 2009, Bennett said. "If you're a doctor seeing a patient, getting feedback on what the doctor did or did not do properly 12 months to 18 months later on is arguably meaningless."

Over time, though, it may be in the doctor's interest to participate.

"The reason that, when this first started, a number of us were in favor of people participating was because we saw the writing on the wall, and this would at least position physicians to develop systems that would be useful in the future," said Dr. Paul Gitman, vice president of medical affairs at North Shore Long Island Jewish Health System in Great Neck, N.Y., and the New York ACP's Quality Task Force Chair.

Glenn agrees. If the PQRI meshes with other quality-of-care initiatives that doctors are involved in and it's not a huge burden, "we've been encouraging them to do it, because this is probably the future of where Medicare's going," she said.

December 15, 2008
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