PQRI (CMS Physician Quality Reporting Initiative)
National research suggests that only about 50% of recommended care is actually provided to patients in the U.S. There are strong trends to public reporting of quality of care data, and payers are increasingly moving to ‘value-based purchasing’ approaches that reward documented excellence in care with reimbursement at higher rates.
The Center for Medicare and Medicaid Services (CMS) announced a new quality incentive program, the Physician Quality Reporting Program (PQRI) for Medicare patient care in early 2007, and has recently extended this program to 2008.
After consulting with national medical societies, CMS published quality metrics for 74 clinical issues in early 2007. Of these, 45 were most applicable to the UCMC Department of Medicine, involving 11 of its 13 clinical sections. Links to each of the measure specifications can be found by clicking each metric.
PCG & Endocrinology– diabetes (A1c, BP, LDL)
Geriatrics & Rheumatology – osteoporosis (screening, bisphosphonate therapy)
Cardiology & Hospitalists – Heart Failure (ACE/ARB), Coronary Disease (Aspirin/Plavix), Myocardial Infarction (Beta Blocker use)
Gastroenterology – Gastroesophageal Reflux (alarm symptom evaluation, EGD referral, UGI use)
Nephrology – ESRD (dialysis ‘dose’, anemia)
Dermatology – melanoma (atypical mole history, skin exam, counseling)
Hematology-Oncology – breast cancer (tamoxifen/aromatase), colon cancer (chemotherapy in appropriate patients), CLL (cytometry), myeloma (bisphosphonates), all cancers (chemotherapy plan documented)
Emergency Department – pneumonia (vitals, O2 saturation and appropriate antibiotic use)
Sample July-December 2007 results can be found here.
CMS has recently announced 119 measures for 2008, retiring some from 2007. We have begun analysis on which make sense for our department. An initial allocation of the 2008 measures by department and section is found here. The AMA has also posted PQRI measure coding sheets and specs here. A useful handook on what constitutes 'success' in each measure is here.
CMS quality reporting programs also include the acute Inpatient Prospective Payment System (IPPS), in which the full 'market basket rate adjustment' for operating and capital payment rates is contingent on a hospital's reporting of quality data.