Physician Quality Reporting Initiative Resources
In 2006, the Tax Relief and Health Care Act authorized spending for physician quality reporting. Out of this, the PQRI was born and administered by the Centers for Medicare and Medicaid. In 2008, The Medicare Improvements for Patients and Providers Act made the program permanent though funding for the incentive was only guaranteed through 2010. The PQRI is a system whereby eligible physicians report whether certain core measures were performed.
For complete information about the program, visit the Centers for Medicare and Medicaid web site. In general, the program is based on certain measures which are reported for patients on Medicare. The program’s measures are based on certain standards of care which are revised yearly. Nine different reporting options are available based on the time period selected for reporting, the measures which are reported, and if claims based reporting is used. Additional information is also available from the American Medical Association’s web site, most state medical societies, and certain specialty medical societies.
The program allows for a maximum 2.0% incentive to physicians who participate. Unfortunately there is not universal participation. There are many reasons for this, including difficulty reporting codes in certain billing systems, difficulty meshing reporting requirements with practice flows, and difficulty determining applicable coding.
For physicians who may not be able to report individual measures, there is another option with reporting of prescription habits for Medicare patients. This reporting has an incentive bonus of 2.0% as well separate from the PQRI reporting. More information can be obtained from the Centers for Medicare and Medicaid website.
Providing quality healthcare is the goal of every physician. Unfortunately, determining what constitutes quality is a more elusive standard. While standards of care have been set by certain medical societies and other regulatory agencies, individual physician judgement should always have a place to care for patients who may not completely meet a standard.
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