PQRI
Medicare Physicians Quality Reporting Initiative (PQRI) Overview
Program Goals
- Collect quality data from healthcare professionals across multiple settings to improve prevention, consistency of care, and outcomes
- Reward quality of care over volume
Benefits of Participation
- 2.0% incentive on total Medicare Part B revenue
- No cap on incentive payments
- Potential for improved patient care
- Establish care alerts and treatment protocol
- Identify and track patients with common conditions
- Promote consistent care throughout the practice
PQRI Reporting Options
Individual measures (total=175): Report on minimum of three PQRI measures on 80% of applicable Medicare patients to qualify for incentive. Measures include:
- Diabetes mellitus - hemoglobin A1c poor control
- Coronary artery disease - beta blocker therapy for CAD patients with prior MI
- Heart failure - beta blocker therapy for left ventricular systolic dysfunction (LVSD)
- Stroke and stroke rehabilitation - carotid imaging reports
- Osteoporosis - screening or therapy for women age 65 and older
- Preventive care and screening - advising smokers to quit
- Ischemic vascular disease – blood pressure management control
- HIV/AIDS – screening for injection drug use
- Hepatitis C – Hepatitis B vaccination in patients with HCV
- Rheumatoid arthritis – functional assessment management
Measures groups (total=13): Report all measures in one measures group on 30 Medicare patients or on 80% patient sample:
- Diabetes mellitus
- Chronic kidney disease
- Preventive care
- Coronary artery bypass graft surgery
- Rheumatoid arthritis
- Perioperative care
- Back pain
- Hepatitis C
- Heart failure
- Coronary artery disease
- Ischemic vascular disease
- HIV/AIDS
- Community-acquired pneumonia
Alternative Reporting Periods
- January 1 - December 31
- July 1 - December 31 (for measure group reporting)
Types of Reporting
- Claims-based
- Qualified registry
- Qualified EHR-based (available for 10 specific measures)
2008 PQRI Experience
- The government paid out $92 million in PQRI incentives.
- Of the 162,800 physicians who attempted to participate, 85,000, (52%), earned some incentive payment.
- Average payment to individual physicians: $1,082.
For more information and downloads:
- CMS Website: http://www.cms.hhs.gov/PQRI
- 2010 PQRI Measures List
