There’s Still Time to Qualify for 2010 PQRI Financial Incentives, but You Must Act Fast
When the Centers for Medicare and Medicaid Services (CMS) launched its Physician Quality Reporting Initiative (PQRI) in 2007, the Heart Center of North Texas explored, but decided against, participating in the program. The effort of collecting and reporting quality measures was so complex and onerous that it was not worth the time or effort involved.
Our nine-doctor cardiology group based in Fort Worth, Texas, maintained its stance for the 2008 reporting year after hearing from participating peers that PQRI remained a daunting challenge and that many participating physicians had not received a cent from CMS for 2007. In late 2009, however, we reversed course for two reasons.
Revamped Program
CMS had revamped the program to address the concerns and frustration expressed by physicians. They did such a good job that PQRI morphed into a program that promised substantial returns for minimal effort – an opportunity we could not refuse. CMS made PQRI more user friendly by expanding quality measures and enabling doctors to report through registries. We found that by partnering with our registry, DocSite (now Covisint DocSite), we were able to gather and forward the required information quickly without interrupting our normal workflow. Our registry then formatted and submitted the data to CMS.
Available Discounts
Another plus was our ability to take advantage of a discount coupon offered by the Texas Medical Association in November 2009. The discount covered most of the registration fee medical groups had to pay CMS for each participating physician so participating in the program did not require an up-front financial commitment. Many state and local specialty medical associations/societies have similar programs, so medical groups should check to determine whether they can take advantage of these discounts.
With the Heart Center in line to pocket a substantial sum without incurring any cost, it did not make sense to spurn PQRI a third time. We made the right call. Last November, CMS paid the practice a PQRI bonus of $87,000.
The Process
To qualify for the bonus, the Heart Center had the physicians fill out the simple questions needed on 30 patients. We utilized an easy-to-use paper template supplied by our registry to collect the data. Gathering information for PQRI was quite easy because clinicians routinely captured much of the required data elements over the normal course of their interaction with patients. No workflow changes were necessary to accommodate PQRI reporting because our physicians and other clinicians already provided high-quality, evidence-based care with an ongoing focus on prevention. Most required information could be pulled from the Heart Center’ electronic health record (EHR).
Dotting the i’s and Crossing the t’s
Once a form was completed, it was reviewed to verify that everything was in order. This attention to detail ensured that accurate data was submitted, which expedited the reporting process and that we would be fully prepared if CMS ever audited the Heart Center or requested additional information. For example, in 2009, CMS asked the Heart Center for documentation proving that the data from one of their physicians reflected 30 patients who had been seen consecutively by that doctor – a provision that is not required to meet 2010 PQRI reporting requirements. The medical group submitted the physician’s schedule as proof, and CMS was satisfied.
Once we were satisfied that all the i’s were dotted and the t’s were crossed, a clerk entered the data from the forms into our 2010 PQRI web registry and the process was completed on our end. Our registry then formatted the files and submitted them electronically to CMS.
The data collection and submission processes went so smoothly in 2009 and the return-on-investment was so significant that we knew we would participate in the 2010 PQRI program, especially since this was the last year to capture the incentives. Because we were busy with upgrading our information technology systems, and we have complete confidence in the efficiency of the submission process, we didn’t start collecting quality measure data until the end of 2010 since we knew that this would still provide our registry with ample time to submit our data to CMS before the March 15, 2011 deadline.
2010 Reporting Even Easier
Collecting data for 2010 turned out to be even easier than in 2009 in part because CMS changed the definition of consecutively seen patients. Now, the reporting physician did not have to see the 30 patients consecutively, which allowed them to go back and gather the data.
As a result of the Heart Center of North Texas’s positive PQRI reporting experiences, we are urging our colleagues to report quality measure data to qualify for 2010 PQRI incentives. Depending on the number of participating eligible professionals, the process should take a few hours to a few days to complete. The submission deadline is March 15, 2011, but registries will need to receive data sooner. An approved registry can offer guidance and discuss deadlines.
Physicians and other eligible professionals who successfully report 2010 PQRI qualify measures can qualify for a maximum bonus payment of 2% of the total allowed charges for covered services payable under the Medicare Physician Fee Schedule. The bonuses will drop to 1% in 2011 and .5% from 2012 through 2014. In 2015, PQRI will essentially become a mandate when Medicare slashes reimbursement by 1.5% in 2015 and 2% in 2016 for non-participating physicians.
With PQRI turning from a carrot into to a stick in three years, we plan to collect the annual PQRI bonus we have earned. It doesn’t make sense that any practice would leave that money on the table when it’s relatively easy to apply for the incentives. With all the cuts in reimbursement, we need to take advantage of any available revenue sources – especially those that reward physicians for providing quality care.