American College of Physicians: Internal Medicine — Doctors for Adults ®


Medicare's new bonus program offers chance to profit today, prepare for tomorrow

From the June ACP Observer, copyright 2007 by the American College of Physicians.

By Brett Baker

The Physicians Quality Reporting Initiative (PQRI), starting July 1, marks the official arrival of Medicare pay-for-reporting. The program enables physicians to receive a bonus payment for successfully reporting on quality measures for services furnished to beneficiaries over the course of the six-month period ending Dec. 31.

The legislation that established the PQRI provides an expectation that the program will continue in some form in 2008, although the law fails to specifically fund a 2008 program. While there is uncertainty surrounding whether Congress will continue to fund the program in 2008, ACP encourages internists to participate now because it will prepare practices for future reporting. College resources should ease your participation—enabling you to collect a 2007 bonus and make the investment that will prepare you for future reporting.

When deciding whether and how to participate in the PQRI program, consider insight from ACP member colleagues. ACP has received comments from members who practice in a variety of settings about their PQRI-related plans. Here’s some of what ACP has heard so far:

  • A small gastroenterology practice is planning to focus on reporting GERD quality measures and using a template with the measures and reporting codes that enable the physician to instruct the billing staff;
  • An academic practice with an electronic health record (EHR) is setting up its system so that it automatically prints relevant information pertaining to its selected quality measures, e.g. a test result, and the quality measure code to report it, to be used by the billing staff; and
  • A member who works for an EHR vendor is working diligently to program the product to alert the physician user of eligible patients/encounters and prompt him or her to send the quality measure code to the billing system.

ACP intends to monitor how participation varies and the extent to which successful reporting varies by practice setting.

ACP understands the importance of ensuring that members are prepared when the PQRI program starts on July 1 and that they are able to participate with minimal burden throughout the reporting period. To respond to these needs, ACP has developed the following information and tools to provide guidance:

  • a checklist that identifies the steps a physician needs to take to participate in the PQRI and a “how-to” document that provides more detailed participation guidance,
  • a list of the subset of the 74 quality measures most relevant to internists,
  • a flow sheet document/template that the physician can use at the time of the reportable encounter/event that alerts the billing staff when to report quality measures and which specific codes to report on the claim form,
  • assistance in identify the beneficiaries for which a physician would report the quality measures he or she selects to report on,
  • coding assistance tools, and
  • access to Physicians’ Information and Education Resource (PIER) clinical content for PQRI quality measures most relevant to internists.

Look for assistance tools and updates on ACP's Web site.

Your reporting experience this year and the ACP experience in working with CMS will help determine how Medicare pay-for-reporting will influence medical practice and patient experiences. ACP intends to use this collective experience not only to shape future pay-for-reporting/pay-for-performance initiatives but to guide the College’s broader effort to reform our healthcare payment system and create incentives for patient-centered care.

Despite the challenges in reporting for the last half of 2007 and the uncertainty surrounding a 2008 program, ACP encourages internists to participate in the PQRI as the experience is likely to be beneficial regardless of future changes.

Brett Baker is director of Regulatory and Insurer Affairs in ACP's Washington, D.C. office.


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