Medicare's Role in Promoting Quality HealthcareIn an area as complex as healthcare, measuring and monitoring quality obviously of great importance is comparably complex. As a step in the direction of mastering the measurement challenge, the Centers for Medicare and Medicaid Services (CMS) began implementing a program called the Physician Quality Reporting Initiative (PQRI) in the second half of last year.
In PQRI's first phase, 74 quality measures were defined (e.g., administering aspirin when a heart attack patient arrives for care). In the program's second phase, being conducted this year, the number of measures has been expanded to 119 (pdf).
A physician who participates in the PQRI program qualifies for a bonus if s/he reports on at least three quality measures on 80% of the eligible patients throughout 2008. (In some cases, there will not be three relevant and available measures. In this situation, the physician need only report the one or two measures that are available.)
The bonus is calculated as 1.5% of all the physician’s Medicare billings, not just the ones on which he or she reports. (The calculation does not include charges for x-ray, MRI, durable medical equipment, or physical therapy.)
There are four basic steps a physician practice follows to participate in the PQRI program:
- Use the list of measures to identify which conditions the practice routinely treats.
- Select those measures that make sense based upon prevalence and volume in the practice.
- Review the selected measures in the Coding for Quality Handbook to become familiar with how to apply the measures.
- Access the data collection worksheets, which walk the user step-by-step through reporting for each measure.