February 1, 2011

Tom Sullivan, M.D.

A Quick Primer on the Physician Quality Reporting System (Formerly PQRI)

Is it worth it to your practice to join this government incentive program? And can you do it without breaking the bank?
The quick answer is yes, if you bill a significant amount of claims to Medicare Part B. And especially so if your practice uses or plans to use an Electronic Health Records solution this year.
But first – what is the Physician Quality Reporting System (PQRS)? What is the overall goal, who’s eligible, and what exactly are the incentives?
In a nutshell, the Physician Quality Reporting program’s purpose is to move physicians and other “Eligible Professionals” away from the traditional Fee-For-Service payment system toward a pay-for-performance fee structure. Congress directed the Centers for Medicare and Medicaid Services (CMS) to start down that path in 2006, and has modified and changed the program almost annually ever since.
Many physicians are understandably wary about the term “Pay for Performance” or “P4P.” To better describe the initiative, Congress has used the term “Value-based Purchasing” and others have used the phrase “Pay for Reporting”. To accomplish this new payment model, the CMS needs to collect data from physicians, variously called “Quality measures” or “Performance measures” for certain common services and diagnoses.
That’s where you, the physician comes in. By reporting clinical quality data on specific medical treatments and/or drug therapies you’re prescribing – like Antiplatelet therapy for coronary artery disease – you help the CMS aggregate important process measures and information that can be used to monitor, track and – over time- improve patient outcomes. And you can receive incentive funds equaling up to 1% of your Medicare Part B billable claims by doing so!
So how do you report this data to receive your funds? You’ve got three options, one of which is through an Electronic Health Records solution. If you are using or plan to use one, this is a tangible way to realize some of your investment back – literally. Contact DrFirst to find out how you could be eligible for the Physician Quality Reporting incentives. You can also opt to report this information on your Medicare Part B claims or to a Qualified Physician Reporting registry.
Be aware that the PQRS program incentives and quality measures mentioned above are different than the Medicare and Medicaid EHR incentives. CMS has stated that over the next few years they will be integrated, but currently, physicians cannot be reimbursed under both the PQRS and the EHR incentive program in the same year.
Now you know the basics of the Physician Quality Reporting initiative! To stay up to date on this and other health care incentives programs, sign up for this blog. We’re going to play close attention in the months ahead to the program’s important milestones and events.
For a link to the CMS PQRS 2011 web page, click below:

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.