Surgery News- July 2008

J U LY 2 0 0 8 • SURGERY NEWS NEWS FROM THE COLLEGE Alternative Reporting Options Added to PQRI BY CAITLIN BURLEY T he Centers for Medicare & Medicaid Services (CMS) has extended the Physician Quality Reporting Initiative (PQRI) through the end of 2008. This voluntary pay-for-reporting program was established in the 2006 Tax Relief and Health Care Act, which mandated the development of a reporting system for professionals with a payment incentive for individuals who meet the participation criteria. Preliminary reports released by CMS in January this year showed that out of more than 631,000 professionals eligible to participate, only a little more than 99,000 professionals attempted participation from July 1 through November 2007. This article addresses changes that have been made in the 2008 PQRI and provides information to help surgeons determine whether to participate. What has CMS done to encourage more participation? CMS has created alternative reporting, released April 15, that allows for new reporting periods and methods. CMS anticipates that the new criteria will give eligible professionals several avenues to succeed and, ultimately, to receive the bonus payment. The two new reporting periods for 2008 PQRI participation are January 1 to December 31 and July 1 to December 31. Both include the options of claimsbased reporting and registry-based reporting, and reporting with these measures groups: diabetes mellitus, end-stage renal disease, chronic kidney disease, and preventive care. What are the options for reporting in the full year? Individuals who participate in the 2008 PQRI from January to December have the following options: Using claims-based reporting, an eligible professional must report on three PQRI measures (one or two if less than three apply) for at least 80% of applicable claims. Using registry-based reporting, an eligible professional must report on at least three PQRI measures for at least 80% of applicable cases. Using registry-based reporting, an eligible professional must choose one measures group and report on 30 consecutive, applicable patients. Using registry-based reporting, an eligible professional must choose one measures group to report on at least 80% of applicable patients. What are the options for reporting in the half-year? The options for participating in 2008 PQRI from July to December are: Using claims-based reporting, an eligible professional must choose one measures group to report on 15 consecutive, applicable patients. Using claims-based reporting, an eligible professional must choose one measures group to report on at least 80% of applicable claims. Using registry-based reporting, an eligible professional must report on at least three PQRI measures for 80% of applicable patients. Using registry-based reporting, an eligible professional must choose one measures group to report on 15 consecutive, applicable patients. Using registry-based reporting, an eligible professional must choose one measures group to report on at least 80% of patients. How are the measures groups used for reporting? Each measures group has four to nine PQRI measures, and health care professionals who choose to use one of the groups must report on all measures within that group. Patients must be applicable to the measures group used—that is, the defined measures are relevant to these patients’ cases. When submitting measures groups through claims-based reporting, physicians must use the G code to signify the first of the 15 consecutive patients. G codes are only needed when using claims-based reporting. What are the specifications for registry-based reporting? On April 15, CMS announced that 12 clinical registries would take part in registry-based reporting as part of a pilot test. The registries were expected to demonstrate that they could submit PQRI data to CMS; that they were in existence on Jan. 1 of this year; and that they could fulfill CMS-specified technical requirements. Names of the qualifying registries will be posted on the CMS Web site by Aug. 31. Eligible professionals also were expected to be able to prove an established relationship with the registry through which they are reporting to CMS and confirm the validity of their data. Which organizations or firms house the 12 clinical registries CMS named as pilot test participants? The Society of Thoracic Surgeons, Cedaron, University of Wisconsin Medical Foundation, ICLOPS, The National Cardiovascular Data Registry, Cielo MedSolutions, American Osteopathic Association, Rush Health Associates, Wellcentive, Wisconsin Collaborative for Healthcare Quality, General Electric, and Phytel. Is there a payment incentive for participation in PQRI? Incentive payments for successful participation have been extended, and the cap associated with the bonus payments for the 2008 and 2009 PQRI has been removed. The incentive is 1.5% for all Medicare Part B services in the reporting period. Is it too late to enroll in PQRI for 2008? It is not too late to enroll. The half-year reporting period provides eligible professionals with opportunities to receive a bonus payment. For more information, visit www.cms.hhs.gov/pqri/ or contact Caitlin Burley at cburley@facs.org. ■ MS. BURLEY is a quality and regulatory assistant in the ACS Division of Advocacy and Health Policy. Clinical Scholars in Residence Program Builds on Success BY CLIFFORD KO he ACS Clinical Scholars in Residence Program is a 2-year fellowship in outcomes research and surgical health care policy. It was started in 2006 to offer residents a unique experiKARL BILIMORIA, ence in the M.D. work of the College’s Division of Research and Optimal Patient Care. The fellowship is designed to address issues in health care quality, health policy, and patient safety, and to help the Clinical Scholar in Residence prepare for a career in academic surgery. Karl Bilimoria, M.D., M.S., the first Clinical Scholar in Residence, has produced more than 25 peer-reviewed publications, 20 national meeting pre- T sentations, and important contributions to the College’s surgical quality programs (including the National Surgical Quality Improvement Program and the Commission on Cancer programs). During his time as the Clinical Scholar in Residence, Dr. Bilimoria earned ANGELA INGRAHAM, a masters of sciM.D. ence degree in clinical investigation from Northwestern University in Chicago. He returns to his general surgery residency as a fourth-year postgraduate at Northwestern this month. His long-term interest is in surgical oncology with an emphasis on health services research. Two new Clinical Scholars in Residence who have demonstrated great dedication to outcomes research and improvement of the quality of surgical care are expected to make similarlymeaningful contributions. Angela Ingraham, M.D., a resident at the University of Cincinnati, Ohio, joins the College this month to further her training and education in an effort to conduct meaningful research that will reduce traumatic injury incidence MEHUL RAVAL, and improve the M.D. care of trauma patients. Mehul Raval, M.D., a resident at Northwestern University, also joins the College in July. He aspires to obtain the skills necessary to conduct effective outcomes research that will contribute to advancements in pediatric surgery and establishing improved practice guidelines. The College also welcomes its first Robert Wood Johnson Clinical Scholar. Stanley Frencher, M.D., is a general surgery resident at Yale–New Haven (Conn.) Hospital who is interested in quality of surgical care, appropriateness of care, and health care disparities. Dr. Frencher, who begins work for the College this month, will be located primariSTANLEY FRENCHER, ly at the UniverM.D. sity of California–Los Angeles Center for Surgical Outcomes and Quality. Applications for the next 2-year positions must be submitted by July 15, 2008. For more information, contact Karen Richards at krichards@facs.org or visit www.facs.org/ropc/ clinicalscholars2009.html. ■ DR. KO is director of the ACS Division of Research and Optimal Patient Care. http://www.cms.hhs.gov/pqri/ http://www.facs.org/ropc/clinicalscholars2009.html http://www.facs.org/ropc/clinicalscholars2009.html

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Surgery News- July 2008 Contents The 20/20 Vision: Health Reform Trauma: Airway Anchor News From the College: Jacobson Winner General Surgery: Worth the Trouble

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