Physician Quality Reporting Initiative

Background

The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries during the period of July 1, 2007-December 31, 2007.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007 (Pub. Law 110-173). MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008.  For 2008, eligible professionals who successfully submit measures will earn a 1.5 percent bonus of their total allowed charges for 2008 calendar year.

2009 PQRI. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) made the PQRI program permanent, but only authorized incentive payments through 2010. EPs who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).

As required by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-173), CMS has established 2 alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries. The 2 alternative reporting periods are: January 1, 2009 – December 31, 2009 and July 1, 2009 – December 31, 2009. In total, there are 9 options for satisfactorily reporting quality measures data for the 2009 PQRI that differ based on the reporting period an EP chooses to report on, whether an EP chooses to report through claims or an approved clinical registry, and whether an EP chooses to report on individual measures or measures groups.

List of Reportable Measures in the Nursing Home Setting

Important Links

2009 PQRI

• CMS’ 2009 PQRI Quality Measures List List (brief description)


• CMS’ 2009 PQRI Measures Specifications (detailed)


• CMS’ Sponsored Calls - these calls provide professionals an opportunity to hear updates on the PQRI program as well as ask questions regarding details on how to successfully participate in the program.


• AMA’s Participation Tools - these useful tools include data sheets for successful reporting of individual measures as well as measure groups.

2008 PQRI

• 2008 PQRI Quality Measures List List (brief description)


• 2008 PQRI Quality Measures Specification (detailed 341 pages)


• CMS’ PQRI Tool-Kit


• List of Patient-Level Measures (measures that only have to be reported only once per reporting period)


• List of approved registries for reporting(including American Board of Family Medicine)

2007 PQRI

• CMS’ 2007 PQRI Feedback Reports User Guide


• MLN Matters: Steps to access you 2007 PQRI Feedback Reports personally


• Accessing your 2007 PQRI Feedback Report

News from the Association (Members Only)

August 2008 - AMDA Participation in PQRI Matches National Participation Rate

August 2008 – PQRI Update at the PPAC

July 2008 - Medicare Quality Reporting Initiative Pays Over $36 Million To Participating Physicians from the 2007 PQRI Reporting Period

April 2008 - CMS Offers Alternative PQRI Reporting Methods

News from CMS