Pennsylvania Practices Make the PQRI Participation Decision
Medicare’s Physician Quality Reporting Initiative (PQRI) is about to mark its first anniversary, so what better time to take stock of the fledgling program?
Nearly 100,000 health professionals participated with PQRI during its first five months, from July 1, 2007, to Nov. 30, 2007. That’s about 16 percent of eligible providers—about half of which were on track to receive a 1.5 percent bonus on all Medicare fee-for-service charges.
The Centers for Medicare and Medicaid Services (CMS) expects those numbers to go up when it gets data back for all 2007 reporting. In addition, CMS expects increased participation in 2008 because more quality measures were eligible for reporting.
Pennsylvania reflects the national average, with practices that don’t participate far outnumbering those that do participate.
Lebanon Valley Family Medicine in Palmyra is one of those that hasn’t participated, but it may start when its computer system is upgraded, practice administrator Shirley Dailey said. Dailey said there aren’t many practices in her area participating with PQRI.
“There would definitely be more incentive to participate if reimbursement levels were higher. It is a lot of work for the reimbursement you receive,” Dailey said.
Dailey said she’s hoping the practice’s upgraded computer system will be able to do a lot of the work, pulling in the information required for PQRI and prompting physicians to ask certain questions when seeing a patient.
Dailey said her practice may participate because one day these types of pay-for-performance programs may no longer be voluntary.
“It’s definitely the wave of the future,” she said.
Kathleen Sharp, CPC, CMM, quality improvement advisor for the Lehigh Valley Hospital and Health Network, has helped the practices in the Lehigh Valley Physician Group participate with PQRI. She agrees that these programs may become mandatory.
“It’s important that we understand the process now,” she said.
Sharp said reimbursement was not their main motivator for participation. Rather, they wanted to improve quality and patient care, see how they measure up to practices throughout the nation, and become familiar with pay-for-performance programs.
“Return on investment is not a motivator in participating with this because it is such a small monetary reward. Initially, it may cost more to participate than what you’re going to get back,” Sharp said.
The Lehigh Valley Physician Group (LVPG) practices collect quality data for all patients who fit into the PQRI measures the practices selected for cardiac and diabetic patients. They only report the data to Medicare and a few commercial payers that accept it.
“We have complete quality data on all of our patients who fit into the PQRI metrics. Internally, that’s very important in improving standardization and quality of care,” Sharp said.
Participating practices, especially those that are paper-based, did see increased work and cost. The biggest impact was not on clinicians, as LVPG thought it would be, but on chart preparation and code entry.
Nevertheless, Sharp said the group plans to participate next year and advises other practices to do the same.
“We know the monetary incentive is very small right now, but it’s good preparatory work to be ready for what may become mandatory in the future,” she said.
Last Updated: 6/12/2008