Client Alerts
PHYSICIAN QUALITY REPORTING INITIATIVE PROGRAM (PQRI)
BACKGROUND
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).The current Medicare Physician Fee Schedule is based on quantity and resources consumed, not quality or value of services. With implementation of the PQRI, Medicare has elected to become an active purchaser of medical services rather that a passive payer, and has taken the first step toward pay for performance. The goal is to enhance the value of patient care, encourage higher quality and avoid unnecessary costs by encouraging the reporting of evidence-based measures of quality care and improving care based on these measurements.
REPORTING
For the reporting period with Dates of Service between January 1, 2008 through December 31, 2008, CMS has identified 119 unique measures associated with clinical conditions that are routinely represented on Medicare Fee-for-Service (FFS) claims. Two pathology-specific performance measures on breast and colon cancer will be used for this reporting period.- Breast cancer patients with pathology reports that have a pT and pN category and histologic grade for their cancer (excluding biopsies)
- Colorectal cancer patients with pathology reports that have a pT and pN category and histologic grade for their cancer (excluding biopsies)
PARTICIPATION
Participation in this program is voluntary and there is no need to register to begin reporting. Eligible professionals can participate by reporting the appropriate quality measure data on claims submitted to their Medicare claims processing contractor. Pathologists must be enrolled Medicare providers and the individual National Provider Number (NPI) must be used on claims. Pathologists who successfully report on 80 percent of all applicable measures will receive a 1.5 percent bonus of total allowed charges on all 2008 Medicare claims for services paid under the Medicare Physician Fee Schedule. The bonus for reporting in 2008 will be paid mid-2009 on all claims identified with the National Provider Identifier (NPI) of successful reporters. Rand will submit the quality measure data on claims that it submits to Medicare. It is the responsibility of the pathologist to provide Rand with the required measurement data in a form or format that will allow for complete reporting. Additional information can be found on the CMS PQRI website at www.cms.hhs.gov/pqri. A PQRI audio conference is available on the CAP website at www.cap.org.