Client Alerts
PHYSICIAN QUALITY REPORTING INITIATIVE PROGRAM
FOR ANESTHESIOLOGY
BACKGROUND
Medicare has identified 119 different standards of quality patient care and they are offering an incentive to physicians who report on the frequency with which these standards are met. In order to obtain the bonus, physicians must report on at least three measures 80 percent of the time, unless fewer than three are applicable. For anesthesiology only one of these 119 defined measures applies with certainty, i.e., how often prophylactic antibiotics are given in a timely manner to Medicare patients who have a pre-operative order to receive such antibiotics. Although many anesthesiologists are assuming the responsibility for the preoperative administration of beta-blockers to coronary artery bypass graft (CABG) patients, CMS has not yet answered the question as to whether the beta blockade or any other measures are "applicable" to anesthesiologists. There are other compelling reasons to not be reporting on beta-blockers until there is further clarification from CMS.
ELIGIBILITY
To become eligible for the Medicare bonus, the anesthesiologist must identify those Medicare patients who have a written, oral or pre-standing order for a preoperative antibiotic and for those patients, the physician must indicate whether the antibiotic was given in a timely manner or not (within two hours of incision for vancomycin and fluoroquino lone, and within one hour for all other antibiotics or at the time of surgery when no incision is required). If there is no order, the patient is not eligible for the study and there is no further action required. It is the responsibility of the individual anesthesiologists to indicate, 1, that there is an order for a prophylactic antibiotic, and, 2, whether the antibiotic has been given in a timely manner or not. For billing purposes, there is no need to document the time of administration or the antibiotic that was used. The appropriate CPT II codes should be submitted on the Medicare claim along with the usual CPT codes for your anesthesiology services.
INTENT
This initiative is intended to gather statistical information about quality patient care. If you provide data for 80 percent of the eligible patients you will receive the bonus regardless of whether the antibiotic was given or not.
PAYMENT
CMS will evaluate the submitted data and will pay the bonus when the 80 percent threshold is met. Payment will be directed to the individual or group whose tax identification number appears on the claim forms. There is a cap on the bonus, but only for anesthesiologists with low volume Medicare practices. For 2008 PQRI, a bulk payment will be made in mid-2009. The bonus payment is the equivalent of 1.5 to 2 percent of total allowed charges for covered physician fee schedule services from January 1 through December 31, 2008. Assuming that 10 anesthesiologists provide 3,600 anesthetics for Medicare patients from January to December, with an average of 14 units per case, for a total of 50,400 units at a conversion factor of $18.29, that would mean total allowed charges of $921,816. The PQRI bonus for the group would amount to $13,827.24. Please note that the 1.5 percent bonus is not fixed, but depends on the total number of physicians, in all specialties, that participate in the initiative and may also be adversely affected by Congress' recent 6 month reversal of the Medicare fee decrease.