Physicians Practice - September 2008 - (Page 28) PUBLIC POLICY A LOOK AT THE NUMBERS First, let’s examine how the program works: Participating practices were required to select at least three measures on which to report from a CMS list of 74 (visit PhysiciansPractice.com for a complete list of these measures), with some specialists required to select only one or two. Participants must report on their chosen quality measures for least 80 percent of reportable cases. The average number of reported measures per NPI number (and you must have one to participate) was 3.58 — higher than required. This is surprising, as participants were not compensated for submitting extra measures. One happy aspect of the 1.5 percent bonus is that it’s calculated on a provider’s total allowed Medicare charges for that payment period, not just the reported measures. But the bonus is all or nothing: There is no partial payment for doing some of the work. Moreover, some payouts were capped under the 2007 rules. The cap, which is not in effect this year, prevented full payout for reporting on measures when the actual reporting instances were too few. So, has PQRI been a success? It depends on your point of view. CMS announced in July that 56,700 physicians — 52 percent of the nearly 110,000 who participated — reported everything correctly in 2007, and therefore will receive their bonuses, which average about $635 per physician. Total payout nationwide: $36 million. So, for these physicians, it can be said that PQRI was a success — if you consider a small bonus, plus the experience gained in participating in a program that is likely to expand, a success. As for the other 48 percent of participants? Well, thanks for playing. They will be paid nothing because CMS decided that they failed to report the data correctly. There is no appeal. Win or lose, all participants can access a personalized, confidential feedback report from CMS that shows their own data compared to all other participants. This report must be accessed through CMS’ security system, call the “Individuals Authorized Access to CMS Computer Service — Provider Community,” or IACS-PC: applications.cms.hhs.gov. RAH! RAH! IN SUMMARY About half of the 2007 PQRI participants will receive a bonus from the program, averaging $600 apiece. What are participants saying about the program? • Upside: The program is fairly easy to participate in, as many reportable measures are normal standards of care. • Downside: There is no way to appeal if CMS rules a physician reported incorrectly. Also, successful reporting through the billing system can be tricky. here to stay. • All sides agree the program is 28 | PHYSICIANS PRACTICE | SEPTEMBER 2008 Marilyn Orr, who was the executive director of Dover Ortho during the 2007 PQRI program (and now serves as executive director at Cincinnatibased Beacon Orthopaedics) says that the practice wanted to be more proactive. “Think of the nature of orthopedic practices — usually reactive,” she says. Broken bones from falls, sports injuries, and the like. The practice decided to focus on safety in terms of drug interactions. “With orthopedic practices, it’s really easy to lose track of all the prescriptions for patients; most are written by the patients’ family doctors,” she says. “Medication reconciliation is a PQRI measure.” Essentially, Dover Ortho used PQRI to set an in-practice goal of ramping up drug safety for its patients. If successful, this would keep patients safer and happier, and earn it some extra money. The practice also has a DEXA scanner. “We found that a lot of our patients were not having bone den- sity scans done,” says Orr. This, too, is a PQRI measure, so Dover Ortho screens more patients and reports on doing so to CMS. Idaho Emergency Physicians in Boise also participated in PQRI, spending several thousand dollars to rig its billing system to handle the PQRI reporting. “We made a decision that if our [billing] system allowed us to, we would participate,” says Tom Peterson, the practice’s, executive director. Peterson figured the practice would earn back its capital layout fourfold in bonus money. Idaho Emergency’s coding manager, Lisa Jolliff, was also heavily involved in the project. “We had to train our physicians to provide accurate documentation,” she says. “But it was easy for them; most of it was just standard of care.” But participating in PQRI did not require new technologies or even updating old ones. Signature Medical Associates in Elgin, Ill., created a paper “cheat sheet” that listed the four PQRI measures it had chosen (smoking assessment, pneumonia assessment, diabetes screening, and heart patients receiving aspirin), according to internist Ron Hirsch. The practice’s seven physicians would circle each measure as they performed them, Hirsch explains, and the sheets would then be sent to billing, where the biller would add the PQRI information to the appropriate claim. READ MORE ABOUT IT! For more information about Medicare’s pay-for-performance program, go to PhysiciansPractice.com and type PQRI in the “Search Site” box. And check out these sites for even more: •Medicare’s own information site: www.cms.hhs.gov/pqri •The American Society of Hematology’s Web site: www.hematology.org •The Medical Group Management Association: www.mgma.org WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM http://applications.cms.hhs.gov http://WWW.PHYSICIANSPRACTICE.COM http://www.cms.hhs.gov/pqri http://www.hematology.org http://www.mgma.org http://WWW.PHYSICIANSPRACTICE.COM
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